Helping Your Doctor With a Difficult Conversation

Our guest blog today comes to us from Dr. Ned Stolzberg, executive medical director at Hospice of the Valley. As National Healthcare Decisions Day/Week draws to a close, Dr. Stolzberg shares his thoughts on the importance of that conversation so many of us struggle to have regarding advance directives and end of life care. This subject is profoundly important to the Arizona Hospital and Healthcare Association (AzHHA). So much so, we sponsor a statewide coalition called “Thoughtful Life Conversations” with tools and resources to make it easier to start that difficult conversation. It is another way we are working toward our long-term goal of making Arizona the Healthiest State in the Nation!

Over the past 10 years working in hospice and palliative medicine, rarely have I had a day when I did not discuss advance directives and goals of care. Typically, patients are grateful to have the opportunity to discuss these issues and relieved that their medical team understands their wishes. What is concerning however, is that these discussions are usually happening late in the game. Making a plan for end of life is no different than planning for any big decision—it is best done before there is a crisis.

So why is this conversation so often delayed until near the end of life? The reason is that up until recently, this discussion has been “doctor driven”—if the doctor didn’t broach the topic it wouldn’t come up at all. I had a private family practice for 20 years and can count on one hand the number of times I had a patient specifically ask for an appointment to discuss living will and power of attorney paperwork. This model needs to change as our population ages and faces greater challenges from chronic disease.

There are a number of barriers to effective communication between doctors and patients around end of life planning. First is time. Too often, this topic takes a backseat to the “ache of the day” and there isn’t enough time remaining for a meaningful conversation. I encourage patients, especially those battling serious illness, to schedule an appointment specifically to go over their advance directives. Do some research ahead of time and go prepared with your questions and forms. Hospice of the Valley’s website (hov.org) is a great place to find resources as is our Health Care Decisions line (602) 222-2229.

Another challenge involves physician comfort with discussing end-of-life issues. Many of us had limited or no training in this area. Unless they have worked in the field, doctors may also have limited understanding of the specifics of palliative and hospice services. HOV works with many of the local medical schools and residency programs to provide training for the next generation of physicians. We also offer educational programs for physicians already in practice, and any physician is always welcome to call if they have questions.

Finally, some doctors are afraid that this conversation will upset their patients. Again, this is why I encourage patients to let their physicians know that they want to talk about their wishes. This gives the doctor “permission” to have an open and honest dialogue about prognosis and options.

Personally, I have always found talking about end-of-life wishes to be one of the most rewarding aspects of practice. It allows for a stronger doctor-patient relationship, a deeper understanding of a patient’s values and a greater clarity when deciding on the best medical course of action. I recommend that both physicians and patients take a proactive approach toward making sure this crucial conversation happens.

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