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

COVID tells us to have “the conversation” now

Ylfa Perry, MD
Physician
May 5, 2020
235 Shares
Share
Tweet
Share

Insurance companies require doctors to ask dozens of questions and click on carpal-tunnel inducing boxes during a yearly physical. However, none of those questions or boxes address one of the most important aspects of a person’s life, their death. So, as a family doctor, I encourage people to think about it, have “the conversation” with loved ones, and complete the paperwork.

I’m also married to a doctor, so the conversation is (relatively) easy for us; we have a lot of practice. But most people don’t, and in the current pandemic, it’s not something you can put off any longer. Now, more than ever, you need to have multiple conversations. Why?

It helps normalize the topic. Every family has members who stick their fingers in their ears and hum the Looney Tunes song the first seven times you bring it up. But, eventually, they’ll come around when they realize why it’s important.

Without the conversation, you give up control over the final act of your life. Every person, after reflecting upon their deepest held beliefs and priorities, can answer the question: “What would be your ideal death?”

Most people say they want to live a full life but not grow so old or ill that they lose a significant quality of life. Then they want to die at home, surrounded by loved ones. I have yet to meet someone who says, “I’d like to lose control of multiple physical and cognitive abilities, then die in an ICU with a breathing tube while a resident splinters my ribs with chest compressions and electrocutes my irreversibly dead heart.” Or, “I want to be tortured with dialysis and a feeding tube for weeks or months before I die alone in a nursing home.”

I know, that seems harsh. That’s why a lot of doctors don’t prompt this conversation until patients are already very ill, leaving the family to guess what the person would have said, had they had the conversation earlier. I’m not going to lie to you; it does suck to be the person who forces people to look at this reality. But it’s my job and, frankly, my privilege to offer the peace of mind that comes with having control over the end of one’s life. After all, the biggest fears around death are the unknown, the loss of control.

I also think it shouldn’t only be health care providers who know the reality of an undiscussed death. Studies show that most physicians will choose hospice early if they have a terminal disease and will opt for a “do not resuscitate” order when they are elderly or otherwise near the end of life. But 80 percent of laypeople in the U.S. die in a hospital or nursing home, without an advanced directive.

The truth is not enough doctors discuss the end of life with patients. And when they do, it’s often like this: “If your heart stops, do you want to be resuscitated? If you can’t breathe, do you want a ventilator? If your kidneys fail, do you want dialysis? If you can’t eat, do you want a feeding tube, so you don’t starve to death?” Of course, people say yes! Common sense and the fairytale depictions of CPR in TV and movies suggest these are obvious decisions. Ah yes, TV and movies, sign. More than half of fictional victims survive CPR. In reality, the statistics are much more sobering.

And frankly, even when a doctor wants to provide all the information and get to know the patient well enough to help them decide, we don’t get nearly enough time.

To give you a more realistic perspective, I’ll provide some basic statistics. However, by far the most important things to ponder and define are: What does “quality of life” mean to me? What makes life worth living: physically, emotionally, spiritually? How much am I willing to risk losing?

OK, the hard numbers. The odds of CPR being successful depends on age, overall health, and what prompts the need for resuscitation (e.g., a massive heart attack in an 80 year old versus trauma in a 35 year old), and whether the event occurs in or outside of the hospital. Outside the hospital, the highest survival rate is for 35 to 64 year olds. And it is 12 percent. It drops to 9 percent for 65 to 74 year olds and 4 percent if you’re over 80. For patients of all ages who are already hospitalized, only 18 percent will survive to be discharged. Of those, about half will have neurologic disabilities.

Decisions about CPR, ventilators, feeding tubes, and dialysis can be outlined on a form called an “order for life-sustaining treatment.”  You also need to complete a health care proxy. If you don’t and you are unable to speak for yourself, your entire dysfunctional family gets to fight over every decision. Even if you have the perfect family (you do not), please designate a single spokesperson. Someone with whom you have often had the conversation.

But even before those decisions, there are many smaller decisions that alter what leads up to the final scene. Each decision is complicated and difficult. But if you’ve spent time thinking about your priorities, explaining them to loved ones, and writing them down, each decision becomes easier. A deep understanding of your priorities cuts a path through the dense jungle of health care.

So, in summary, if I could have one wish, it would be, like Steve Martin, “that all the children of the world could join hands and sing together in the spirit of harmony and peace.” But if I had a second wish, it would be that doctors had the time to have meaningful conversations about the medical and personal/spiritual side of advanced directives. But they don’t. So you have to do it. For yourself. For your loved ones. Starting today. Now.

Ylfa Perry is a family physician.

Image credit: Shutterstock.com

Prev

COVID-19 is becoming boring

May 5, 2020 Kevin 0
…
Next

Vulnerability is challenging but necessary for health care professionals

May 5, 2020 Kevin 0
…

Tagged as: COVID, Infectious Disease, Palliative Care

Post navigation

< Previous Post
COVID-19 is becoming boring
Next Post >
Vulnerability is challenging but necessary for health care professionals

Related Posts

  • Finding happiness in the time of COVID

    Anonymous
  • Birthing in the era of COVID

    Jennifer Roelands, MD
  • How to get patients vaccinated against COVID-19 [PODCAST]

    The Podcast by KevinMD
  • COVID-19 divides and conquers

    Michele Luckenbaugh
  • The ethics of rationing care during COVID

    M. Bennet Broner, PhD
  • State sanctioned executions in the age of COVID-19

    Kasey Johnson, DO

More in Physician

  • The essence of health narratives, including poetry

    Arthur Lazarus, MD, MBA
  • Discover the power of patience

    Diane W. Shannon, MD, MPH
  • Doctors rediscover joy in practicing medicine, on their own terms

    Kim Downey, PT
  • Physician return-to-work policies

    Deepak Gupta, MD
  • How my patients’ Zoom backgrounds made me a better doctor

    Joseph Barrera, MD
  • Understanding reproductive rights: complex considerations

    Anonymous
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
  • Past 6 Months

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

      Tami Burdick | 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
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Addressing dual diagnosis needs in addiction treatment

      Susan Hertz Berrick, EdD | Conditions
    • The essence of health narratives, including poetry

      Arthur Lazarus, MD, MBA | Physician
    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician

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

Leave a Comment

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

  • CDC Proposes 'Morning After' Pill to Prevent STIs
  • A Framework to Communicate With Pregnant Patients About the RSV Vaccine
  • Chronic Stress and Dementia; Hormones and Brain Health; Dementia Protection Neurons?
  • Physicians, Here's How to Increase Your Pay
  • Low Relapse Rates With Twice-Yearly Schizophrenia Treatment

Meeting Coverage

  • Low Relapse Rates With Twice-Yearly Schizophrenia Treatment
  • Menopause Can Negatively Affect Women's Careers
  • Sexual Activity Lowers Risk of Side Effects After Cervical Cancer Treatment
  • Hot Flashes: Precursor to Alzheimer's Disease?
  • SABR Offers New Hope for Older Patients With Inoperable Kidney Cancer
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
  • Past 6 Months

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

      Tami Burdick | 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
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Addressing dual diagnosis needs in addiction treatment

      Susan Hertz Berrick, EdD | Conditions
    • The essence of health narratives, including poetry

      Arthur Lazarus, MD, MBA | Physician
    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician

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

Leave a Comment

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

Loading Comments...