There are a number of reasons for the perceived lack of relationship between LOS and health outcomes. Clearly reducing days of care at the low-intensity end of a hospital stay may not necessarily affect health outcomes. There is a case to be made for tailoring care more exactly to an individual's needs by looking at the actual components of care rather than the place of care--within or outside hospital walls.

In search of a good death Doctors need to know when and how to say die Editor-One of the main obstacles to the care of dying patients is the taboo against speaking or writing about impending death. Here are a few simple tests to see how you or your colleagues are doing. Try reading a selection of charts of patients who have died. Patients do "poorly," "fail to respond," or are "palliative," but I would wager that you will find few patients described as "dying" or "near death." Some dying patients even "demand" futile treatment such as cardiopulmonary resuscitation in the event of a "cardiopulmonary arrest," when asked to "consent" not to receive it. You should also see how often and how vigorously you avoid talking about death when speaking to a patient likely to die. I am always surprised at how difficult I find it to talk openly about death and dying, even when it clearly is necessary and appropriate and I have carefully thought out what I am going to say. If compassionate care of dying patients is to occur doctors need a structured and consistent approach to talking with patients about death and dying.