NCRIC Feature:  Discussing End-of-Life Issues with Patients

The following article is provided by NCRIC, Inc., the medical professional liability carrier endorsed by MSDC.  NCRIC, Inc., is a member of the NCRIC Group family of companies.

The recent public struggle to determine the private wishes of Terri Schiavo regarding her end-of-life medical treatment has raised popular awareness of the importance of advance directives and living wills.  Physicians are naturally a principal resource for curious and concerned patients.

Death is a natural part of life but talking about it isn't.  Most people are uncomfortable discussing end-of-life issues and even physicians tend to avoid them.  A study published in the Journal of General Internal Medicine, however, indicated that a large majority of patients are interested in discussing end-of-life issues with their physicians.  Most expect their physician to initiate such dialogue.  Additionally, a study by Dr. William Tierney, a professor of Internal Medicine at Indiana University, found that patients were pleased when their physicians brought up the topic of advance directives. 

The goal of talking with your patients about the future and advance directives is to document what the person wants at the end of life. A popular version of an advance directive that acts as a tool for discussing the issue with patients is known as Five Wishes. When talking with your patients, ask the following questions to help simplify and focus the discussion:

• Whom do you want to make healthcare decisions for you when you can't make them?
• What kind of medical treatment do you want?
• How comfortable do you want to be?
• How do you want people to treat you?
• What are your wishes for your loved ones?

Moments of crisis are not the best time to discuss end-of-life issues. These discussions need to start long before a medical crisis. The following are some additional tips for starting an end-of-life discussion with your patients:

• Make a discussion about advance directives a routine part of an initial visit with all competent adult patients. Explain that you consider this an important part of comprehensive medical care.
• Consider having literature available that discusses advance directives with the initial packet of information given to new patients.
• Suggest web sites where your patients can obtain additional information about advance directives and end-of-life issues.

NCRIC policyholders can learn more about various end-of-life issues and how to handle these discussions in our new home study course, "Talking to Your Patients about End of Life," available online at www.ncric.com