(Snippets from the frontline)
Hospice care? Really?
I was asked to evaluate a patient for hospice care by an agency.
Arriving at her home, she was sweeping the porch as we introduced ourselves. A minute later, her daughter joined us in conversation.
She had been in a hospital and diagnosed with bladder cancer. My discussion with her revealed no pain or suffering, and no constitutional symptoms like poor appetite, weight loss, or fatigue. Nor did she have nausea, abdominal pain, or blood in her urine. Vital signs were stable, and her physical exam was normal.
I asked if I could see the medical record and found the “terminal diagnosis” needed for hospice admission was made by a urine cytology report revealing “abnormal cells.”
The hospital HMO group was anxious to discharge the patient according to the daughter, so the doctor recommended hospice care. No CT scan of the abdomen was done, no cystoscopy to exam the inside bladder, or cancer oncologist consulted.
Evidence-based standards of medicine were not used to confirm a “terminal diagnosis”, so I challenged hospice admission.
The daughter took her mother back to the HMO doctor and demanded an appropriate work-up.
Later I was told there was no cancer.
Gene Uzawa Dorio, M.D.
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