Doctor-Patient End of Life Discussions

Beginning in 2016, Medicare now provides reimbursement for End of Life Discussions between doctors and patients.  Curious about the effectiveness of this policy, I began reading.

Not surprising, numerous articles reference how uncomfortable doctors are having these conversations.  Doctors are trained to heal and to save, while seeing so often the impact of critical illness, accidents and death.  Patients on the other hand are largely unfamiliar with the impact of critical illness, accidents and death.  How do we go about bridging the chasm between doctors and patients?

For the majority of people in the US, the perception exists that end of life discussions are for “older people”.  While none of us enter the world with a known expiration date, it is known we will not live forever.  Medical schools are now providing additional training to students focused on questions to ask patients while remaining focused on prognosis, care and preservation of hope for patients.

NPR released an article last month titled, “Doctors Unsure About How to Talk with Patients About End-Of-Life-Care”.  The John A. Hartford Foundation joined the California Health Care Foundation and Cambia Foundation in presenting the findings of a national poll exploring the views of primary care and specialist physicians about end-of-life and advance care planning conversations with patients.

In “Conversation Stopper,” virtually all physicians surveyed agree that talking with patients about end-of-life and advance care planning is important, and they overwhelmingly support a new Medicare benefit that reimburses them for having those discussions. The survey also identified barriers that keep physicians from engaging in these sensitive conversations, with nearly half (46 percent) reporting that they frequently or sometimes feel unsure of what to say, and less than one-third (29 percent) reporting having had any formal training specifically on talking with patients and their families about end-of-life care.  Click the link below to read the full article.

Doctor Patient End of Life Discussions

What type of person are you?  If the doctor did not initiate a conversation with you about your preferences for care, treatment and quality of life, would you initiate this discussion? This is about YOU – your preferences, wishes and desires may not be front to mind while healthy, yet if something changed, could anyone speak for you, if you were unable to speak for yourself?

Getting clear about what you want, how you want it and initiating action can be empowering.  Knowing you can modify your choices, decisions and plans opens up the door for taking action about considering and documenting your wishes.  Readiness at any age can take courage, compassion and planning.  Action invested while you are healthy provides peace of mind.