Recently I was in a situation where a 90 yo severely demented women, DNR/DNI, for altered mental status ultimately attributed to a UTI was admitted to our service. Pt was on tele monitoring and asymptomatic atrial flutter was noted. Now rather than going home the pt will spend an extra one to two days hospitalized for treatment of her a-flutter which she did not notice. Additionally our cardiology service recommends anticoagulation now with followup INR checks and cardiology clinic followup.
It is no wonder that our health costs our soaring when we are going to these measures in a 90 yo demented person who declared DNR/DNI status prior to dementia. Medicine has become so algorithimized with treatment fit for populations, where is individualization? Sure we are going to follow the currently recommended treatment options for a-flutter, that's easy and docs feel good following the these flowcharts but where is the part in taking each individual case in to account? Should this lady really be spending extra hospital time, with extensive followup and INR checks?
It is no wonder that our health costs our soaring when we are going to these measures in a 90 yo demented person who declared DNR/DNI status prior to dementia. Medicine has become so algorithimized with treatment fit for populations, where is individualization? Sure we are going to follow the currently recommended treatment options for a-flutter, that's easy and docs feel good following the these flowcharts but where is the part in taking each individual case in to account? Should this lady really be spending extra hospital time, with extensive followup and INR checks?