Ever hear the joke about “Chi Chi”? Dr. Mehmet Oz, Oprah’s health care guru, told me the joke during an interview on his show, the “Dr. Mehmet Oz Show,” on Oprah & Friends XM Radio 156. He used the joke as a metaphor for end of life care. It literally took my breath away.
The joke reads as follows: A hostile tribe captures two explorers. The tribesmen drag the explorers before their Chief.
The Chief asks the first explorer, “Death, or Chi Chi?” He obviously doesn’t want to die, so he responds, “Chi Chi!”
Three beefy tribesmen bludgeon him almost to death.
The Chief then turns to the second explorer and asks, “Death, or Chi Chi?” He doesn’t want to suffer the same fate as his partner, so he responds, “Death!”
The chief then says, “Ok, but first Chi Chi.”
When Dr. Oz told the joke, I almost fell of my chair because of the truth he spoke about medical decision making at the end of life in a US hospital setting. I’m lucky I had the wherewithal to finish the interview! The joke illustrates perfectly in metaphorical terms how a lot of people die in this country in hospitals. No one talks about it, but this is commonplace in end of life care in the US health care system.
At some point in a patient’s trajectory at the end of life, a dignified death might have been possible. Instead, like the Chief, the doctors on the patient’s healthcare “team” say, “Ok, but first Chi Chi.” In Dr. Oz’s words, they then proceed to torture the patient’s body over the course of the final two weeks of life!
In my opinion, the issues of reimbursement in health care delivery and fragmentation in patient care rear their ugly heads yet again. This time in relation to end of life care.
In the US health care system, we reimburse doctors based on the number of procedures they perform in medical care. Component management is the standard of hospital care, with “a doctor for every organ.” Consequently, in hospital care, if something happens to one organ, you see a specialist for that organ; if something happens to another organ, you see a specialist and subspecialist for that organ, and so on.
Specialists multiply on a particular case based on referral, and no doctor wants to interfere with another doctor’s ability to make money. Quite simply, doctors compete for finite reimbursement dollars.
As a result, no one looks after the whole patient!
I have witnessed time and again a typical scenario in end of life Patient Care Conferences: one doctor argues with the other doctors on the healthcare “team” about how “his” organ is in good shape— it just needs a bit more time to ‘get over the hump’. Every other specialist on the healthcare “team” argues the very same thing about their respective organs.
Meanwhile, family members remain in a state of bewilderment. No one seems willing to tell them what’s going on with the whole patient. They are left largely to their own devices to somehow piece together bits of information from each specialist and subspecialist in an attempt to get a complete picture of what’s happening to their loved one.
Time passes as doctors continue to perform their Chi Chi on the patient.
Dr. Oz and I agreed, a network of relationships with key hospital personnel (clinical and non-clinical) is the only way family members or patient advocates (caregivers) can empower themselves to think clearly and act in the best interests of the patient. Patient empowerment and caregiver issues can only be addressed through relationships and not simply by the use of electronic medical records.