Anne Elizabeth Denny's Nov 30. commentary, "We need to drive end-of-life planning," was both very important and very inaccurate.
Important because she calls attention to the topic of advance care planning, which really is "what do I want when I am dying?" Inaccurate because the tone and the verbiage of her article suggest that doctors are not prepared to help our patients with the advance care planning.
The idea of advance care planning is gaining traction in our society. We should give thanks to Ms. Denny and the many others championing the efforts to bring this topic to our attention.
I agree with her comment that patients should drive the discussion. Our deaths are potentially beautiful, painful, frightening, sad and a relief. I join her in encouraging all of us to consider what we desire when our lives are coming to a close. The medical professionals who care for you want you to have an advance directive.
I disagree strongly with her characterization of doctors as being unprepared to help our patients with advance care planning. I have been discussing and filling out the forms she describes (and states I am unprepared to do) for most of my 26 years in practice. I discuss with patients their fears and desires as they struggle with cancer, lung disease, heart disease and many other issues. To suggest that doctors are unprepared or have no training to provide our patients with guidance is wrong and insulting.
Doctors are fabulous students of above-average intelligence and constantly develop new skills needed to manage the complex nature of medicine. Certainly we are capable of helping our patients with these documents.
The anecdotal story of Denny's friend's mother who suffered a tragic accident and was then approached by multiple doctors with multiple plans for her care is illustrative of a misrepresentation and common flaw in the end-of-life discussion. Her friend told Denny she wished "one person could have woven together the entire picture for her mom's care."
The implication is that having an advance care directive will be the "woven" story of her wishes, thus preventing multiple doctors from discussing the terrible events and how to care for her. This is simply wrong.
Despite your best efforts, you will not anticipate every possibility for the end of your life and therefore will not have in your directive what to do in all circumstances. So what you and doctors are left with is a patient and family with options and choices to be made. By all means, fill out the directive, but illness and death are very challenging and cannot be anticipated.
Fortunately for all of us, you are left with a bunch of hardworking doctors and providers who have committed to being there in your family's darkest hour to struggle through the difficult issues. If people truly want to die at home, as I do, then make arrangements that allow that to happen. Not coming to the hospital for care is an option. The fact that 70 percent of us die in a hospital or nursing home reflects not a lack of an advance care directive but of a national psyche not comfortable with the idea of death, a desire to control pain, get well and live, which is not always possible.
Lastly, Denny suggests that Medicare should not reimburse doctors for the discussion of advance care planning. Really? We deal with death and dying daily. The lack of appreciation for what a doctor does is astounding. The suggestion that we shouldn't be paid for this because we aren't qualified is ridiculous. I have been doing it for 25-plus years without reimbursement. Maybe there will be back pay? I do know that Denny is available for speaking engagements.
Please discuss and do your advance care planning. Know that doctors have knowledge and wisdom that can help with the discussion. Also know that despite your best plans, if things don't go as expected at the end of life, doctors and all health care providers will strive to help you to a peaceful death.