What are the Odds? | Caring Choices

As I sat at the computer checking our luck on the most recent Powerball drawing (we didn’t win … again), I wondered about the odds of actually winning. According to the PA Lottery website, the odds of winning ANY Powerball prize are about 1:32. The odds of winning the Powerball jackpot (multi-millions of dollars) are 1: 175,223,510. Not very good odds of winning either way you look at those numbers. But it is fun to play once in a while. And there’s that saying: “You can’t win if you don’t play.” Of course, there’s no real loss in playing the lottery if you’re spending (and can afford to lose) a few dollars a week. It’s when the stakes are higher that the loss can be devastating.

Earlier today, I read an article in The New York Times about a long-term acute care hospital serving patients in Connecticut who seem to have wagered bets in a kind of healthcare lottery. Whether they have won or lost is something only they and their families can determine.

There are several statements/quotes in that article that struck me as key to helping people be knowledgeable, contemplative and responsible healthcare consumers. I’ve underlined words that really stand out to me:

Long-term acute care is “where you go when you survive but you don’t recover,” Dr. Nelson said.
Deciding to have a tracheotomy should be a difficult decision for family members, she added. But, she said, “people misunderstand — they think it is a sign of hope.” Few doctors discuss the likely consequences or the alternatives.
But the likeliest reason for the disconnect, he said, is that families are initially dealing with I.C.U. physicians who are focused simply on keeping the patient alive: “They are discussing how the patient is doing today, not how they will be doing in six months,” he said.
“People are not prepared,” Dr. Nelson said. “There is one intervention after another. Ventilator, feeding tube, permanent feeding tube, permanent intravenous access. ‘Should we treat this infection?’”

The patients and their families in the NYT article faced difficult decisions. The choices made them dependent on ventilators (or other permanent medical technologies) that now require 24/7 acute care in hospitals which may be states away from where their loved ones live and work. Whether these decisions were the ‘right’ ones or not is not for this writer to decide. What I hope the sharing of this article accomplishes is getting people to have serious, thoughtful conversations about the types, benefits and risks of healthcare choices long before a medical crisis or traumatic accident occurs.

Just like playing the lottery, odds of “winning” in serious medical situations narrow as the jackpot gets higher. Factors that impact the odds include our age, our physical health going into the crisis, and the scope and severity of the crisis itself. When a person doesn’t win in the health care lottery, s/he isn’t simply out a few dollars. And s/he isn’t the only one who loses. The loss of time is immeasurable; the loss of independence is irreplaceable; and the loss of this magnitude does not easily provide endless chances to “play” over and over again.

Caring Choices believes that healthcare discussions and choices should not be a gamble. Educate yourself about your medical condition(s) and available treatments, and benefits & risks, including short-term and long-term outcomes.