Barry Ashpole’s Media Watch (#476)

AUSTRALIA | The Guardian (U.K.) – 17 August 2016 – For decades, Australia led the world in recognising the importance of assessing the value new medicines provide to its citizens and ensured the prices Australians paid for these medicines reflected their value. As a result, the health of Australians has been among the best in the world, a feat achieved at levels of health- care spending that have fallen well below na- tions such as the U.S. Indeed, within the U.S., health policy scholars have frequently viewed Australia’s healthcare system as a model of how care can be delivered efficiently to an entire population. Meanwhile, the notion drug prices can reflect value has escaped the U.S. health marketplace. But Australia’s dominant position at the forefront of public health policy innovation and therefore its global health advantage lie in question. Healthcare treatments are quickly evolving, as is our understanding of how treat- ments affect society at large, an issue is particu- larly important with an ageing population that must be cared for by others. This rapid evolution means Australia’s system for determining which drugs are available to the population will need to adapt to ensure treatments that provide value to society continue to be accessible to Australians. https://goo.gl/SfGFxB

Australia – Intensive care specialists’ knowledge, attitudes and practice relating to the law about withholding and withdrawing life-sustaining treatment: A cross-sectional study

CRITICAL CARE & RESUSCITATION, 2016; 18(2):109-115. Participants included 867 medi- cal specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting (emergency, geriatric, pallia- tive, renal and respiratory medicine, medical oncology, and intensive care). Intensivists per- formed above average in terms of legal knowl- edge, but important knowledge gaps remain. Intensivists had a more negative attitude to the role of law in this area than other specialty groups, but reported being seen as a leading source of information about legal issues by other medical specialists and nurses. Intensivists also reported as being the specialty most frequently making decisions about end-of-life treatment. Improved legal knowledge and open engage- ment with law can help manage the risk of harm to patients and to protect Intensivists from liability. http://goo.gl/3WjHuw

Article highlighted to be of particular interest:

We doctors see death all around us, but we don’t like to think about our own

THE WASHINGTON POST | Online – 15 August 2016 – Physicians, like most people, do not want to discuss the implications of their own mortality. We forgo difficult conversations, assuming that our wishes would somehow be innately known by our friends and families. Haven’t we always been told that all doctors want the same thing? Indeed, a 2014 survey confirmed that an overwhelming majority of physicians – almost 90% – would choose no resuscitation.1 Most doctors also report wanting to die at home rather than in a hospital. Perhaps it is these general assumptions that make physicians not feel the need to explicitly discuss and outline their end-of-life preferences. In a survey of almost 1,000 physicians whose mean age was 68, almost 90% thought that their family members were aware of their wishes for end-of-life care.2 Almost half of those surveyed did not think their doctor was aware of their end-of-life choices, with 59% of those participants having no intention of discussing these wishes with their doctor in the next year. But we know that conversations about proxies and advance directives should happen long before they need to be utilized. A 2016 study found that physicians were as likely to be hospitalized in the last six months of life as were non-physicians.3 On average, they also spent more days in intensive care units at the end of life and were as likely as others to die in a hospital. So why are doctors dying in hospitals and in intensive care units instead of at home, when we know that their wishes tend to align with avoiding extreme measures at the end of life? https://goo.gl/urTxcO

‘Do unto others: Doctors’ personal end-of-life resuscitation preferences and their attitudes toward advance directives,’ Plos One, 28 May 2014. [Noted in Media Watch, 2 June 2014, #360 (p.11)] http://goo.gl/3M0BF1
‘Life-sustaining treatments: what do physicians want and do they express their wishes to others?’ Journal of the American Geriatric Society, 2003;51(7):961-969. http://goo.gl/aID91z
‘How U.S. doctors die: A cohort study of healthcare use at the end of life,’ Journal of the American Geriatrics Society, 16 May 2016. [Noted in Media Watch, 23 May 2016, #463 (p.12)] http://goo.gl/dKCZ2a