Medicare needs to pay for this. I spend somewhere between 10-30% of my patient time talking about end-of-life (since I'm a hospitalist) and I don't get compensated for it. I have to do it because the doc I cover for are either chicken shit to talk to the families or they don't want to spend the time to do it because of lack of financial incentive.
One person in the ICU on a vent on 2 drips with an ICU nurse and 5 consults would cost about $15-$20K/day. Usually that patient never even gets to say bye to the family and the guilt stricken family turns on each other and on the nurses and physicians - so everybody tip toes around the issue. It needs to be discussed well in advance and have the plan updated routinely.
People spend more time picking their cable and cel phone plans than picking EOL choices
