Tuesday, October 4, 2016
Knowing a Patient’s End-of-Life Wishes is Just the Beginning
Medical Director for Post-Acute Services
Advance care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, making health care plans for the future is an important step toward making sure you get the medical care you would want, even when doctors and family members are making the decisions for you.
As a doctor and trusted partner in my patients’ health, it’s my job to help them understand why it’s important to think about advance care planning now and inform family members of their decisions. Research shows that patients want their physicians to talk with them about end-of-life decisions.
The depth of conversation required for effective advance care planning differs from patient to patient. For example, the conversation and level of planning with a healthy 18-year-old patient will not be the same as the one with a patient who has chronic illnesses. However, the basic approach can be the same—ask the patient who should make medical decisions in the event of an unexpected accident.
There are various phases in your health that might trigger a conversation about advance care planning. As an adult, you are never too young or too old to discuss your plan.
• Phase 1 – An adult patient at any age who is healthy or has a curable condition
• Phase 2 – A patient with a new, chronic condition diagnosis
• Phase 3 – A patient with progressive, frequent complications
• Phase 4 – A patient who is hospice eligible
Supporting documentation in the absence of a conversation is less valuable compared to a conversation and no documentation. A family may not remember the contents of a signed document, but they will remember words their loved ones have said to them. However, the next step of effective advance care planning is to complete documents such as living wills.
There are many resources for documenting your plan. Just as the conversations about advance care planning fall on a spectrum, some documents are more appropriate than others at various stages of care. A stepwise approach based on your health status and the use of formalized documents will structure advance care planning to better serve you.
But the conversation doesn’t end once you’ve documented your wishes. Make sure you share your documents with your primary care physician and local hospital, if appropriate. Also, share the documents with the family member or friend who will speak for you when you cannot. Make sure they do not have any questions.
Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know about your preferences. Everyone has a health horizon. You should plan for it.
Vipul Bhatia, M.D., is the Medical Director for Post-Acute Services at WellSpan Health. He is also the director of WellSpan’s Horizon Planning program. Additionally, Dr. Bhatia holds a MBA in Medical Services Management from Johns Hopkins University. Education: Medical School—BJ Medical College, India; Residency—WellSpan York Hospital; Board certified in Internal Medicine.
For more information about WellSpan Health, visit WellSpan.org. To learn more about WellSpan’s Horizon Planning, visit WellSpan.org/HorizonPlanning.