As a physician I am invested in helping people feel better, treating and sometimes curing disease, and preventing death whenever possible. But I am also acutely aware that there are significant limitations to what we can do with health care, and that it is possible to cause much harm with the tests, medications, or treatments we have available. Alternative or complementary medicine can help in many situations, but even that doesn’t address what I see as a serious problem with health care today. And there is a truth none of us like to think about: every one of us will die!

About 25% of Medicare health spending is spent in the year prior to a person’s death. Is that wrong? Not necessarily. The U.S. spends dramatically more than any other country on health care, but we are not living longer or better. Are we expecting things from our health care dollars that they can’t deliver? I believe so.

It could be argued that doctors know more about healthcare than anyone else. And many of them choose NOT to have the dramatic high-tech interventions that are often brought to play especially near the end of life. Doctors die too.

This conversation is not about money! It’s about expecting something from our health care system that it cannot deliver. In many ways large groups of our society have developed an entitlement mentality – expecting someone else to deal with the results of our behavior, and to take care of us without our doing anything in return. That mindset impacts healthcare when people expect their doctor to “fix” them after they have lived a lifestyle that led to their illness, expect insurance companies to pay for anything and everything, and the government to pay for it if insurance won’t.

Managing your lifestyle behaviors is hard. And so is thinking about the possible end-of-life healthcare options you want or don’t want. So here are a few things I want to suggest in light of the limitations of medical care and the reality that we all live only once:

  1. Live intentionally. That includes your health behaviors. Don’t blame someone or something else. So what if it’s hard? Change what you need to change, whatever it takes!
  2. Think through what you want about your own end-of-life care. And talk about it with your family, doctor, etc. If you need a source for a possible advanced health care directive, consider It may be an uncomfortable thought and conversation, but just do it!
  3. Remember that this world is not the end, and that our life here is temporary. Make things right between you and those you love, and between you and God, while you have time.

Do you think there can be TOO MUCH health care? And if so, when is it too much? What do you want for yourself and your loved ones? I’d love to hear from you.