0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Clinical Crossroads: An 88-Year-Old Woman Facing the End of Life-Reply

Joanne Lynn, MD
JAMA. 1997;278(12):978. doi:10.1001/jama.1997.03550120038021.
Text Size: A A A
Published online

In Reply.  —An ordinary dying person, an elderly woman with end-stage heart failure, cannot count on good care in our patchwork system. Our needs when dying of chronic disease in old age are mismatched with a service system bent on rescue. Each of these letters advocates the service approach of the author(s). Most likely, however, reform will require learning new arrangements that make good care routine. We need a few years of vigorous innovation and research, aiming to learn how to regularly ensure worthy living in that last phase of life. Otherwise, our inefficient and often ineffective system will soon be overwhelmed by the large number of baby boomers facing the end of life together. Dr Solomon may be correct that managed care offers opportunities for improvement, although the evidence to date is disheartening. The adjusted rate of mortality in Medicare managed care is only 63% of expected,1 whereas the Veterans

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();