Futile Care, Dignity at the End of Life, and Physician-Owned Hospitals

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🎯 Why Listen

When an 88-year-old with dementia lands in the hospital, should we implant a device simply “because we can”? The panel examines futile care, ICU economics, malpractice fears, and the cultural bias to always “do something.” With special guest JP Kolcun, a seventh-year neurosurgery resident, they also debate whether physician-owned hospitals could restore dignity, efficiency, and leadership to American medicine.

👥 Co-Hosts

• Dutch Rojas – Founder, Bliksem Health
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur
• Special Guest: JP Kolcun, MD – Seventh-year neurosurgery resident, Rush University, Chicago

📌 Episode Overview

The panel examines costly end-of-life interventions like Watchman devices, asking whether they truly benefit frail patients and what dignity looks like when medicine defaults to “doing something.” In the second half, they debate physician-owned hospitals, exploring how lifting ACA restrictions could improve efficiency, reduce burnout, and restore physician leadership in patient-centered care.

💬 Notable Quotes

• “Wherever the art of medicine is loved, there is humanity.” – Hippocrates, quoted during the episode
• “Government is a poor deployer of capital.”
• “Who would you rather have running a hospital—someone oath-bound, or someone only bound by greed?”

📚 What You’ll Learn

• Why left atrial appendage occluders spark debate about futility and cost at the end of life
• How Medicare’s spending patterns shape hospital incentives
• The tension between physician judgment, family wishes, and systemic pressures
• What Section 6001 of the ACA did to physician-owned hospitals
• Why physician-led care models could improve efficiency and morale in healthcare
• Broader reflections on dignity, values, and the role of physicians in society

⏱ The Episode (Timestamps)

• [00:01:30] Introductions, JP Colcun rejoins the panel
• [00:04:00] End-of-life spending and Watchman device outcomes
• [00:08:00] The 40% mortality problem in device patients
• [00:13:00] Futility, family wishes, and medical-legal pressures
• [00:17:00] Medicare’s role and distorted spending incentives
• [00:22:00] Dignity, third-party payment, and lost physician “quarterbacks”
• [00:30:00] Transition to physician-owned hospitals
• [00:33:00] Section 6001 of the ACA explained
• [00:36:00] Physician burnout and hospital inefficiencies
• [00:44:00] The nonprofit hospital paradox
• [00:50:00] Closing reflections: restoring physician entrepreneurship and values

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X