Why are doctors so reluctant to discuss end of life care?

A recent study suggests that doctors may put off holding end of life care discussions that involve subjects like advance directives, hospice or site of death.

Recommendations suggest that physicians hold these conversations when patients have about a year to live, but the data shows  those guidelines aren’t being followed.


According to the study’s authors, they suggest that doctors “may not be comfortable discussing it,” and, “these conversations are time-consuming and difficult. Some doctors may feel patients will lose hope. It’s easier to say, ‘Let’s try another round of chemotherapy,’ instead of having a heart-to-heart discussion.”

They also point out that medical schools spend little time giving students formal training in holding an end of life care discussion.

That’s all true, but I’ll add one more reason. Time.

Time is simply not valued within our fee for service-based health system. These complicated issues require input, not only from the patient of course, but the family as well. The fact that doctors practice in a system that discourages lengthy office visits, it’s no wonder that more are shying away from this imperative issue.


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