Dying at 75, more shared decision making, and rampant C-sections in Brazil: RightCare Weekly
September 25, 2014
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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The most provocative article this week is from Ezekiel Emanuel, MD, for his piece in The Atlantic on “Why I Hope to Die at 75.” The article is a compelling narrative of how American end-of-life care causes suffering for patients and families, yet hasn’t provided the extra years of vibrant and active life that it promised. Emanuel’s personal priorities and hopes for his life: to be remembered as vital and active, and to avoid the decline he sees as synonymous with extended aging.
Many people will disagree with Emanuel’s ideas about what makes life worth living, but they needn’t feel threatened by them, either. Having a system that provides right care means, among other things, that he and others who share his beliefs should be allowed to exercise personal preferences. At the same time, people who want their life extended as much as possible have the opportunity to exercise theirs.
A new IOM paper calls for the expanded use of shared decision making as an essential component of improving healthcare delivery. Shared decision making is a stronger form of collaboration between caregivers and patients, and involves helping patients understand all their medical options as well as their own values and preferences. Substantial research has shown that patients given access to decision aids, which are commonly used in shared decision making, make better-informed decisions that are better aligned with their values. Lown Institute Senior Vice President Shannon Brownlee is among the authors of the paper.
Vikas Saini, MD, president of Lown Institute, believes that we need a healthcare system in which shared decision-making is embedded in the habits and culture of all concerned — and while decision tools are wonderful technical aids, we should all keep our eyes on that ultimate prize.
Medical culture and traditional sexual mores are cited as the reasons that pregnant women in Brazil undergo C-sections at an alarming rate. In private hospitals, some 82 percent of births are by C-section, and in public hospitals, nearly half are. In her piece in The Atlantic, writer Olga Khazan quotes Simone Diniz of the University of São Paulo on why doctors, and sometimes patients, prefer surgical births. “Childbirth is something that is primitive, ugly, nasty, inconvenient. It takes long, and the idea is we have to make it fast…there’s a sense that you need to either accelerate it or do a C-section.” The WHO has, until recently, recommended that C-sections be limited to only 15 percent of all births.
Those of you who attended our last Lown Conference may remember that Paulo Borem, MD, shared the results of a remarkable project in Brazil that reduced C-sections by half in a short time. The secret: systematic education and engagement of both providers and patients. In other words, a multi-pronged effort to change the culture of medical practice work.
We closed applications for our Young Innovator Grants on Sept. 12, and we’re thrilled with the response we received. Thank you to all who applied! Read about the proposals in our infographic.
If you’re enjoying what you read in RightCare Weekly, we hope you’ll get more involved in the RightCare Alliance! Come to our first regional conference, October 11 in Denver, CO, or email firstname.lastname@example.org for information on hosting your own event!