Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How doctors can discuss advance directives with patients

Juliet K. Mavromatis, MD
Patient
July 17, 2010
725 Shares
Share
Tweet
Share

A recent blog post and series of responses on KevinMD.com aroused my interest.

Dr. Kevin Pho posed the question: Why are doctors so reluctant to discuss end-of-life care? Responders, including patients, doctors, nurses, and even a veterinarian highlighted the stress inherent in this discussion for patients and for medical professionals alike.

To me, the real issue is not whether the discussion should occur, because clearly it should, but when and how? The topic can be very sensitive for a patient who may perceive that their physician is “giving up” on him or her, or that the physician believes that death is imminent.

What constitutes a discussion of end of life care? Though there are many facets to this discussion, amongst health care professionals it most commonly refers to a discussion about an advance directive, a written document stating patient preferences for treatment and designating a surrogate decision-maker, should the patient become incapacitated and unable to communicate.

The two primary components are also known as living will and durable power of attorney for health care. In 2007 Georgia enacted legislation replacing Living Will and Durable Power of Attorney for Health Care with the Georgia Advance Directive for Health Care, which combines elements of these two previous documents.

I admit that in my own practice I often do not broach this topic, particularly with young and middle-aged patients, because of my personal biases, believing that most healthy people, when asked, would want (as I would) to be offered all life-sustaining treatments unless there was no chance of meaningful recovery. But admittedly this thinking is likely flawed. Certainly there are healthy people who would want surrogate decision-makers other than their next of kin, thus the discussion becomes important.

What is meaningful recovery? Can this really be spelled out in the form of an advance directive? I am somewhat skeptical. I believe that one has to know a person really well in order to understand that person’s concept of meaningful recovery. I personally feel that the surrogate decision-maker part of the directive is much more meaningful in clinical practice than is the living will portion.

That being said, I am a strong proponent of encouraging patients to discuss these issues with their family members, who are the ones who will likely need to come to consensus in times of question regarding the direction of end-of-life care. If filling out an advance directive document facilitates this discussion with your family and your physician then the process in itself is as beneficial as the document.

Can doctors be taught to talk to patients about end-of-life issues? I was fortunate to participate in a medical school curriculum for this at Emory University, published by Dr. Alexia Torke and Dr. William T. Branch in the Journal of General Internal Medicine. Workshops with role-playing exercises may be helpful in teaching medical students strategies to ease these discussions.

As with many aspects of medical communication physicians should be culturally sensitive when discussing death and dying with patients. One study of impoverished African-American patients at the end-of-life highlighted the importance of understanding spirituality to grasp this population’s view of death and dying.

The whole concept of “advanced directive” seems a very American notion, accepted especially by those of higher socioeconomic status, but not well understood by those of other cultures, who may feel it’s up to the doctor to make recommendations, or who may have deeply spiritual beliefs about the nature of death and one’s ability to orchestrate it.

So I take it back to both doctor and patient. Doctors, assess your patients’ views about end-of-life of care and provide them with information about advance directives; and patients, think about these concepts on your own and with your families and surrogate decision-makers so that when the time comes we are all on the same page.

Juliet K. Mavromatis is an internal medicine physician who blogs at Dr Dialogue.

Submit a guest post and be heard.

Prev

ER visits rise because of prescription drug abuse

July 17, 2010 Kevin 1
…
Next

A new primary care payment model with health savings accounts

July 18, 2010 Kevin 9
…

Tagged as: Patients, Primary Care

Post navigation

< Previous Post
ER visits rise because of prescription drug abuse
Next Post >
A new primary care payment model with health savings accounts

More by Juliet K. Mavromatis, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Applying the new cholesterol guidelines to real life patients

    Juliet K. Mavromatis, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Drugs that are not FDA approved: Is there a time to prescribe them?

    Juliet K. Mavromatis, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How to know whether alternative medicine is safe

    Juliet K. Mavromatis, MD

More in Patient

  • There’s no one to drive your patient home

    Denise Reich
  • Dying is a selfish business

    Nancie Wiseman Attwater
  • A story of a good death

    Carol Ewig
  • We are warriors: doctors and patients

    Michele Luckenbaugh
  • Patient care is not a spectator sport

    Jim Sholler
  • Me is who I am

    Michele Luckenbaugh
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Motorcycle helmet laws: Balancing freedom and financial impact

      Stephen Cohn, MD | Conditions
    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • The link between orofacial myofunctional disorders and dental health

      Stephanie Jeret | Conditions
    • How compassionate leadership saved this physician [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Why patients write: stress relief, self-care, and sharing experiences

      R. Lynn Barnett | Conditions
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Did Gabapentin Improve Post-COVID Olfaction?
  • Fentanyl Death Trends; Food Additives and Heart Disease
  • What If the Doctor Is Out?
  • Reduced Mortality Seen in Cancer Survivors Who Meet Exercise Guidelines
  • CDC Advisors Endorse Maternal RSV Vax to Protect Newborns

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Motorcycle helmet laws: Balancing freedom and financial impact

      Stephen Cohn, MD | Conditions
    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • The link between orofacial myofunctional disorders and dental health

      Stephanie Jeret | Conditions
    • How compassionate leadership saved this physician [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Why patients write: stress relief, self-care, and sharing experiences

      R. Lynn Barnett | Conditions
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How doctors can discuss advance directives with patients
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...