Concern for the Terminally Ill
The article on the elderly terminally ill and cancer screening caused me extreme concern (“Elderly Terminally Ill Undergo Unnecessary Cancer Screening,” January 2011, p. 32. Hopefully, we all went into medicine primarily to help patients have as good a life as possible for as long as they have.
Anyone who has been in practice for 30 years, as I have, knows of many patients who supposedly were terminally ill and yet lived for 5-7 years in spite of their physicians’ predictions. When I have a patient with an incurable illness, I always continue to offer her regular mammograms. Otherwise, I would be implying, “you’re going to die anyway, so why screen for breast cancer?” This type of attitude can be psychologically devastating to the patient.
The recommendation in the article that an incurable cancer patient not be screened for cholesterol is simply ridiculous. Even if she is only going to live for 2 years, why would I want her to have a heart attack in the meantime? It is not a very big step to go from the opinions expressed in the article to strict health care rationing, in which patients can no longer get coronary artery bypass graft surgery or kidney transplants because they are no longer of use to society.
We need to consider the psychological aspects of telling patients that we are no longer going to see them for routine screening, as well as the fact that we often do not know how long a terminally ill patient will live. We should continue to try to keep them as well as we can for as long as we can and not give up just because they have been diagnosed as incurable.
Robert J. Shalowitz, M.D.
Glen Dale, W.Va.