Rounding Turn 4

I love track and field. I am an admitted track and field junkie. 

I ran track in high school. I ran track in college.  I volunteer coached at my old high school for 4 years after college. I catch the track & field events on TV whenever I can (ESPN2 is the likely spot). I make it a point to attend the New Balance Indoor Grand Prix meet each year at the Reggie Lewis Center in Boston if I can.  (FYI it’s this weekend and tickets are still available!)

I’ve met some incredible athletes and have seen some amazing races – some triumphant wins and some disappointing losses. 

I’m not sure what it is about track but I still get butterflies in my stomach watching the start of races.  I am typically on my feet as the runners round turn 4, no matter which race it is. In just about every race, rounding turn 4 means you’re in the home stretch.  Your race is almost over. 

It’s a funny sport – track & field.  Though you’re part of a team, it can be very individual in the execution of the races and events.  When I ran, there were folks cheering, but no one was pushing me from behind or pulling me from the front.  When I got tired, there was no tagging out and having a fresh body come in. 

It was just the track and I.  Rounding turn 4…almost at the end.

The question before a race is this: are you ready?  Did you train and prepare for the race?  Did you develop a race strategy?  (Yes, strategy in track and field is incredibly important.)  Did you have conversations with your trusted coach or advisors about your race?

Many times the training is there, but it is the execution of the race where things go wrong.  So strategy becomes that much more important – coming up with a race plan and sticking to it until the race is over.  It gives you the best chance to win the race or, at the very least, allows you to feel good about the race you’ve just completed.

Where am I going with all of this?  I’m sure you’re not reading to hear this windbag’s old track stories. (If you are, let me know – I’m always willing to share old track stories.) 

The title of this blog is A Musing Healthcare Blog.  So I’ve got to tie this in to healthcare somehow. 

Here goes…

In addition to being like a box of chocolates, life is also like Track & Field.  There are teammates and fans and folks to support you, but it’s up to you to run the race.  It’s up to you to round turn 4 and finish the race.  No one can run the race for you. 

Are you prepared? Have you trained? Have you held the race strategy talk with your trusted coaches and advisors?

In healthcare, there is one talk in particular that often does not occur nearly as much as it should – the end of life talk.

It sounds morbid. It’s not something that can typically be brought up comfortably during a Super Bowl commercial or at a relative’s birthday party. But it is incredibly important.  In fact, there are some who have made it their duty to bring about end of life conversations.  More on this later.

If you were to ask someone to rank the importance of dying the way they would want to die (at home vs. hospital, with full medical intervention vs. without/limited intervention) on a scale from high to low, they would probably rank it pretty high.  Not being in control of your care, ending up a “burden” to your family…these are not attractive options.  By having the end of life conversation with a loved one you can reduce the chances of ending up with an unattractive option. 

It is not something that should be overlooked.

So what do you talk about when discussing end of life?  The following site provides a framework for the conversation. 

Overall it includes things like where you want to die, how much intervention you prefer and whether or not there is someone who can speak on your behalf if you are somehow not able to speak for yourself.  From a personal perspective, these are very, very important things for a loved one to know.

Can you imagine a situation where your loved one is incapacitated due to injury or illness and is on life support?   The prognosis is poor. Your loved one is not conscious.  It is up to you to make a decision about continuing care. 

Or how about a situation where your loved one is fully conscious but in a great deal of discomfort and the quality of life is incredibly diminished.  The choices are to go home and die as peacefully as possible or fight tooth and nail to the bitter end with experimental treatments.  What would you want?  Do you know what your loved one wants?

To bring a less personal and more business-like approach to the conversation – what about the cost aspect of this?  According to this article Medicare spent $55 billion dollars in 2009 for doctor and hospital bills in the last 2 months of patients’ lives with 20-30% of that medical treatment having no meaningful impact.

This is not to say that money should not be spent in end of life care. Far from it.  “Meaningful impact” likely means different things to different people, right?

But what if each person involved in that $55 billion Medicare spend had held the conversation about end of life care?  What if some, after having the conversation, decided that limited intervention was how they chose to die? And what if that limited intervention saved 10% of the $55 billion spend? 

The Federal Government, your insurance company, fellow tax payers and possibly your employer would very much appreciate it if you held the conversation.

And before you think that doctor knows best, keep in mind that even the best intentions of your doctor may not be the best course of action for you.  Amy Berman of the John A. Hartford Foundation knows this only too well.  It’s not always easy to stand up to the healthcare system, but it’s easier to do when you and your loved ones have had the end of life conversation.

When you look at this topic more closely, there are very few “cons” to having the end of life conversation with loved ones.  Yet how many of us have actually had these conversations?  With Mom?  Dad?  Husband?  Wife?  Grandma?  Children?

I’m ashamed to say that I haven’t.   But it’s something I intend to remedy soon.

Because when I round turn 4, I want to make sure that I’m following my race strategy and completing my race the way I want it completed so I can feel good about it at the end.

Whether that end is kicking and screaming the whole way or simply accepting and welcoming it…well, that’s for my love ones and I to discuss.

Now if you’ll excuse me, there’s a very important conversation I need to have with my wife. And it’s not about attending the track meet this weekend…though I’m probably going to try to work that in there as well.  Like I said…I’m a track junkie.

El Paquete de Beneficios, 5th Edition, coming soon to Beyond Healthcare Reform Blog!

The hugely successful Paquete de Beneficios (otherwise known as The Benefits Package) is coming soon to a theater near you!  And by “theater near you” I mean the Beyond Healthcare Reform blog written by the fine folks at the law firm Faegre & Benson, LLP.

Set your alarm clocks now.  The latest edition will be published on Monday, February 7th. And if you’re a benefits blogger, send your submissions to by 5PM Eastern on Friday, February 4th.

Heck, I’m going to get cracking right now on my own submission for this gala event!