Ask the Doctor: August 2009

Question: I have been hearing a lot about these “death panels” in the healthcare reform bill.  Does that mean when I need a knee replacement the government will decide whether or not I am too old to get it?

Answer: First of all, let me debunk this misinformation about the “end-of-life” provision in the healthcare reform bill. There is a provision in the bill for reimbursement to physicians when an end-of-life discussion takes place. However, this does not mean that you will have to go in front a panel of government officials to determine if you are worthy of your knee replacement.

Nor will it encourage assisted suicide or euthanasia. In fact, it penalizes doctors for such suggestions. The bill does acknowledge that this conversation is important for you and your doctor (not government officials) to have when, and if, it becomes necessary.

This part of the bill has been terribly misconstrued in the media.

The bill also acknowledges “end-of-life” discussions cannot be reasonably covered in the short 10-15 minute office visit you usually have when you see your doctor.

The last end-of-life conversation I had in my office included my patient, her daughter and her husband. They all needed to be in the room so that the family members (the ones who ultimately need to know what the patient’s decision is), the patient and I could all be on the same page.

First, we addressed her reasons for this visit and adjusted her medications accordingly. That took the usual 15 minutes I am allowed by my schedule for these visits. Then the end-of-life conversation took an additional 30 minutes.  This conversation cannot be rushed. My patient and her family needed to understand that with her medical conditions, if she were to be placed on a ventilator, she may never be able to come off of it.

This by no means meant that I was trying to coerce her into not seeking all measures that could be taken to prolong her life; but she and her family needed to understand what was entailed in life-prolonging measures and have a realistic expectation of the outcome.

No final decision was made in that office visit, but she and her family were going to continue the discussion at home now that they were provided all the necessary information.

Under the the healthcare reform bill, I would be compensated for the time I spent with the patient, and thus recognizing and acknowledging the importance of that conversation. This concept is not new; as a doctor I have this conversation frequently. What is new is the understanding that such a conversation cannot be held in the short time of a traditional office visit.  In direct answer to your question, no one will EVER decide if you are worthy of a knee replacement!

Question: I have been hearing more about preventing Alzheimer’s disease.  My grandfather died of Alzheimer’s. What can I do to reduce my risk?

Answer: There has been some research released about this topic recently.  It turns out that what is good for your heart is also good for your brain, a healthy diet and exercise!  Specifically, in the Journal of the American Medical Association’s most recent issue (August 12, 2009) there is a study that looked at the Mediterranean diet and exercise.

The Mediterranean diet and regular cardiovascular exercise significantly reduced the risk of developing Alzheimer’s disease.

However, DO NOT think that going down to Greektown to have flaming cheese every night constitutes following the Mediterranean diet! The Mediterranean diet consists of no processed food. It consists of whole grains, fresh fruits and vegetables, olive oil and fatty fish like salmon that contain omega-3-fatty acids.

This also does not include lobster dredged in butter! The Mediterranean diet specifically does not include red meat, poultry, or dairy products. This is a strict diet to follow and does not include goodies like Oreos or ice cream from the local dairy treat on a summer day. However, following it closely and combined with cardiovascular exercise, you will be able to live a long and healthy life!  In addition, previously released Alzheimer’s research has shown that the more you use your brain by reading or doing crossword or number puzzles, the lower your risk of developing Alzheimer’s disease.