Is Your Doctor Prepared to Care for You at the End of Life?

Is Your Doctor Prepared to Care for You at the End of Life?

Many physicians lack the training to provide patient-centered end-of-life care.

As the author of the New York Times best-selling book, Being Mortal, Dr. Atul Gawande is challenging the medical establishment to redesign patient care in the final stages of life. With insight and compassion, he addresses the elephant in the Emergency Room as families confront healthcare decisions for a loved one at the end of life.


Author and Physician, Dr. Atul Gawande

Author and Surgeon, Dr. Atul Gawande

Dr. Gawande spoke here in Minneapolis earlier this month, and I was privileged to attend. In my world, he’s a hero.

On the first page of his book, Gawande recounts his medical school discussion on mortality. About an hour… that was it. The discussion focused on Tolstoy’s classic novel, The Death of Ivan Ilyich.

Most practicing physicians avoid the topic of mortality. It is the enemy. Most have received little-to-no training regarding geriatric and end-of-life care. Only recently have a few—emphasis on few—medical schools incorporated end-of-life care into the standard curriculum.

No wonder that many—perhaps most—physicians feel ill-equipped to compassionately and effectively manage the care of a dying patient. As Gawande points out, physicians are trained to fix problems.

Death is treated as a medical problem to be solved. In fact, it is not.

Embracing death as an inevitable and deeply personal journey is a significant paradigm shift for practicing clinicians. Investing time in meaningful conversation to discern a patient’s understanding of her condition, fears, concerns, and hopes for living as fully as possible to the very end of life feels unnatural; it requires a softer approach. It doesn’t solve the perceived problem. It is a skill set few have developed.

Transitioning a patient to palliative care, and eventually to hospice, calls for the physician to address the whole person. The doctor needs to gently guide and support the patient through the journey, instead of assertively, even invasively, treating the patient as a body with a disease. It is uncomfortable for most doctors. To a physician, acknowledging the dying process feels like surrendering to the disease.

Do you want a more peaceful passing? It’s not the default.

Most adults—84% according to one study at the University of Michigan—want less invasive care in their final days. If that describes you, will your physician be prepared to honor your wishes? Perhaps not.

For decades, our healthcare system has delivered more care at the end of life, not less. Your physician, or the hospitalists who are caring for you, might be unwilling to allow the dying process to unfold without intervention.

Physicians are trained to pursue the next treatment…and the next.

For the physician, it can be difficult to accept a patient’s preference to forego additional treatments that just might buy more time. For many patients—and maybe for you—time is not the only factor. There’s more to living than just continuing to breathe.

Your best offense and defense includes 5 key actions.

You can experience a more peaceful end-of-life journey by:

  1. Writing and effectively communicating your healthcare instructions through a Healthcare Directive.
  2. Choosing the right decision-makers as your healthcare agents—who will zealously advocate for your wishes—by completing a Healthcare Power of Attorney.
  3. Proactively preparing your loved ones to understand and honor your preferences by having a family meeting where you share your wishes.
  4. Proactively speaking with your physician to ensure he or she will honor your choices at the end of life.
  5. Ensuring your Healthcare Directive is readily accessible. Your directive should be included in your medical record. Your directive must also be available to your healthcare agents via online storage or paper copies.

Take the lead.

Next time you visit with your physician, consider initiating the conversation about your preferences for medical, emotional and spiritual care at the end of life. Regardless of your age or health status, this is a worthy conversation to begin. Doctors are human beings, too. Most feel inept at starting the dialogue. Take the lead. You, and your doctor, will be better prepared for whatever future medical decisions are required by starting the conversation now.

QUESTION: Do you have any suggestions on beginning this important conversation with your healthcare provider? Will you please join the conversation by sharing this post via social media with your comment using #endoflife?

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