Sunday, August 12, 2012

Do hospitals do futile procedures for profit?

I've been a nurse a long time. I've been at the hospital where I work a long time. When I started here the hospital was by itself, now it is part of a large corporation like most hospitals.

As it became a larger corporation, it changed. There were moves toward "standardization" and "increased efficiency". I've seen medicine change and become big business. At this point it feels more like a business than a place where people get cared for. I guess thats reality.

As with any business, emphasis is placed where the money is made. Cardiac medicine has become a huge money maker. Cath labs make millions putting in stents. Hospitals are doing more and more sophisticated procedures like putting in LVADS (left ventricular heart device), heart transplants. They are doing CRT (continuous renal replacement therapy). Another technology is called ECMO which, if I understand it, is continuous cardiac bypass to rest the heart. This stuff is becoming like science fiction.

There are nurses who say that these procedures are being done on people who will die anyway, in other words they had no chance to begin with. They think some of it is inappropriate. The thing is it makes a lot of money for the hospital and the cardiologists. I wonder if down the road there will be an investigation of all of this. Profiteering at the expense of realistic patient care.

Hospitals are scrambling to stay afloat. I wonder how many are doing procedures that are questionable in an effort to do that. There are already rumblings about stents being no more effective than drug therapy in prolonging life.

The emphasis in hospital is on the areas that make money. They look like hotels. The rest of the hospital is like the ghetto things shabby and falling apart. How far will all of this technology, and along with it money making, go? It will be interesting to see.


BossNurse said...

I left working in CVICU 12 years ago because of exactly what you are talking about. It seemed like we were doing all these crazy procedures (ECMO, LVAD, etc.) on people who ultimately ending up dying anyway. I just felt like I was making them suffer in the last weeks/months of their lives and I couldn't take it any more. I'm glad of the 8 years of experience I gained in critical care, but I don't miss it. Not one little bit.

Nurse K said...

There's a doctor that all the ICU nurses say is doing expensive procedures on dead people, and a lot of those people feel like it's an ethical issue, and have come to work in the ER. WELCOME, come one, come all.

hoodnurse said...

We actually have an ER doctor like this. It makes me sick. If there is an invasive billable procedure to perform in a code, he's gonna do it, even when it's obvious the patient has been dead for hours. He'll practically intubate anyone who coughs and then inserts pretty much any tube he can sans the Foley. His charting is NUTS and is pretty much always skirting the edge of fraud. It's been brought to our medical director's attention multiple times, but apparently it's subtle enough that no one can/cares to do anything about it. It's freaking gross.

Mark p.s.2 said...

Have you not seen the science fiction show Dr Who?
Like the first microchip has doubled in power every year, these machine that keep people alive are slowly getting better every year.
One day our brains will be kept alive inside a robot machine and we will live forever doing some horrible job.

Ivan Ilyich said...

"I wonder if down the road there will be an investigation of all of this."

The problem is already under investigation in at least one hospital group:

Anonymous said...

My complaint is just the opposite. I Work in Community Hospital ED where the docs are scared to death to place a CL in septic pts so we can monitor Svo2!! Really??? We have 1 count them 1 machine to monitor the patient!!! Sad, very sad...

TheTracker said...

Two problems here (well, three):

1. Unnecessary stuff doctors and hospitals do to make money. Most of the victims here are pretty healthy. Unnecessary tests, scans, caths, bronchs, trachs, surgery.

2. Despite futile stuff we do on people who needed a palliative care consult, like, yesterday.

Two different flavors of idiocy, though no doubt sometimes they overlap.

3. Just get a VBG and estimate SvO2 from that. True SvO2 is overrated. And if your doctors aren't comfortable with central lines, you don't want to see the kinds of complications they can inflict with one.

TheTracker said...

Desperate, not despite.