End of Life Talks

A recent survey  of nearly 1,700 by the California HealthCare Foundation found that 76% of respondents did not have written advance directives even though 40% said they had talked with a loved one about what medical treatments they would want at the end of life.  Even worse, only 8% of the patients had ever been asked about end-of-life treatment wishes by a physician even though 80% of patients believe it is important to have their end-of-life wishes in writing. Want some more numbers?  Here are the things that mattered most to people at the end of their lives:

  • 67%: Making sure family is not burdened financially by my care
  • 66%: Being comfortable and without pain
  • 61%: Being at peace spiritually
  • 60%: Making sure family is not burdened by tough decisions about my care
  • 60%: Having loved ones around me
  • 58%: Being able to pay for the care I need
  • 57%: Making sure my wishes for medical care are followed
  • 55%: Not feeling alone
  • 44%: Having doctors and nurses who will respect my cultural beliefs and values
  • 36%: Living as long as possible
  • 33%: Being at home
  • 32%: Having a close relationship with my doctor

That is a lot of information.  The advanced directive discussion should not be taken lightly.   The idiots who came up with the “death panel” complaints are just that…idiots.  I, as a doctor, am guilty of rarely having these talks with patients. We could save so much money for our healthcare system if we did a better job educating patients and respecting their wishes. That being said, we need a better system in place to do it and we need more time which means a better way of paying for these talks.  I challenge anyone to handle that list above in fifteen minutes.  Then multiply that by 1000 or 2000 just for your aging population panel.   Anyone have some solutions or ideas?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “End of Life Talks

  1. KIm D.
    March 8, 2012 at 6:23 pm

    I’m sure it is difficult for Dr.’s to have this discussion as they feel it’s their job to make you well. That doesn’t always happen. When my husband was diagnosed with cancer, I brought his living will into the oncologists office. He handed it back to me saying it was much too early for that. I still think before you need it is when you should have it on file. You can always change it if you feel differently. My husband died 49 days later, at home where he wanted to be.

  2. Pat Nagle
    March 7, 2012 at 10:50 am

    I don’t see why such discussions need to be with an MD, since they are primarily mental/emotional/spiritual issues. Of course, lots of docs are excellent counselors, but not all by a long shot. Perhaps there’s a need for counseling specialists to whom docs can refer. Probably cheaper, as well. (disclosure: I’m a retired school/mental health/addictions counselor).
    I’m 77, and in unjustifiably good health (On top of a ladder yesterday, hanging a heavy mirror; rode a motorcycle until last year’s accident; consistently good lab results; etc.)I’ve made living will, etc. Most geezers I associate with are comfortable talking about these issues.

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