Anaesthesia Pain Intensive Care and Emergency A.P.I.C.E. PDF
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In 2000 it was reported in Time magazine  that while 70% of Americans wanted
to die at home, approximately 75% died in medical institutions and over 30% of
those spent their last 10 days of life in an intensive care unit (ICU). Other studies
have shown that approximately 50% of all deaths occur in the ICU . Approximately
70% of Canadians now die in hospitals . Not only is it not what people want,
but as a result many of the families have faced financial hardship .
We spend about 50% of our health budget on patients who are in their last
6 months of life . Given the choice, many of these patients would probably have
cheerfully forgone the pain and suffering of major procedures if they had received
more balanced information about their care.
How did this situation occur? Like many simple questions this one has complex
answers. With increasing specialisation in medicine, there has also been fragmentation.
The general practitioner (GP) would have delivered most health care before
the Second World War; GPs now often serve as the first triage point for seriously
ill patients on their journey into acute hospitals. There is pressure from families to
do everything possible even if the family doctor suspects the patient is dying.
Moreover, family physicians do not necessarily feel comfortable with dying patients;
nor are they logistically able to provide time-consuming care to the dying
patient at home. Because medical advances are reported on a daily basis, the GP
does not necessarily know of the latest options available for medical care. It is easier
to just call an ambulance. The dying patient is then triaged in the emergency
department at the front door of the hospital. Emergency physicians or doctors of
first contact usually see their role as resuscitating patients, not plucking them off
the conveyor belt and letting them die. There may be potentially reversible aspects
to their disease which require further tests and interventions…