When I first became a doctor, there was broad understanding of this fact. There was even a saying: “Pneumonia is the old man’s friend.” I am an internist who treated older patients. The saying means that there comes a time in life when pain, frailty, dependence, and dementia come together to make a life that is not worth living. That is why my writing is all about staying healthy longer.
My mother was a vibrant, active 91 year old woman who was still traveling independently with her best friend four months before suffering a stroke. Because of her previously excellent health, her physicians recommended surgery to clear the residual debris. She agreed and had a very successful outcome, including moving to an inpatient rehab center - walking, chatting, wearing makeup and worrying about how quickly her hair might grow back. Less than two weeks after her original surgery, there was another massive stroke that left her unresponsive and helpless. My brother and I consented to providing nutrition via feeding tube for three days to see if she might improve; however, nothing changed. We had no hesitation in withdrawing all life support because she had expressed her opinions on 'maintaining a body' abundantly clear for many years. I'm so glad we gave her that chance recover and equally glad we could assure a peaceful end to her very well-lived life.
Thanks Annette. It is always great to hear from you and that is a perfect example of your mother making her wishes clear and then her family honoring her wish. You gave her a chance to show the direction she was going with her clinical condition. When it became clear she would not recover to a level of function she wanted, you did not apply extraordinary measures to keep her here. It is a beautiful story.
Insurance reimbursement does not pay for the most important things: Doctors using their brains, and the lifesaving, life affirming therapeutic doctor patient relationship which ultimately reduces costs and use of resources.
Trust is at the core. Team based care encourages planning for spontaneity. What’s the process for starting the conversation? Are there organizations in the community that are helping with filling out the paperwork?
I worked with a doctor in 2014 and forward who preferred Five Wishes.
They will send 2 free end of life booklets per address, with additional copies for a few dollars. H.E.L.P.
Over the years I have bought many H.E.L.P. booklets to help friends begin to consider what they want their end of life to look like. Written in completely plain English asking very simple questions it helps you consider your quality of life. it's completely understandable and it's a good thing to do with a loved one before the end-of-life.I suggest everyone get a copy and go through it And answer the very simple questions. Your loved ones will be grateful that you did it.
Good to address this issue, Bill. Thank you. Americans have, in general, a terrible relationship with death. We glorify it, we fear it, we deny it, we see it as “other,” but we don’t help people with the experience. Which, after all, is universal. And most Americans don’t trust health care “providers,” and don’t have a personal physician whom they trust. So most of us are abandoned in this important time of need for support. Fortunately, there are thousands of hospice workers and volunteers helping and providing this support. But not enough, and with not enough funding or community backing. It’s a distressing situation and one that doesn’t look as though change is coming to it. Best regards, David
Thanks David. That is a great summation. You are right. Too many people don't get enough support. Internists spend a lot of time with dying people They always appreciated being with their family and hospice support.
My mother was a vibrant, active 91 year old woman who was still traveling independently with her best friend four months before suffering a stroke. Because of her previously excellent health, her physicians recommended surgery to clear the residual debris. She agreed and had a very successful outcome, including moving to an inpatient rehab center - walking, chatting, wearing makeup and worrying about how quickly her hair might grow back. Less than two weeks after her original surgery, there was another massive stroke that left her unresponsive and helpless. My brother and I consented to providing nutrition via feeding tube for three days to see if she might improve; however, nothing changed. We had no hesitation in withdrawing all life support because she had expressed her opinions on 'maintaining a body' abundantly clear for many years. I'm so glad we gave her that chance recover and equally glad we could assure a peaceful end to her very well-lived life.
Thanks Annette. It is always great to hear from you and that is a perfect example of your mother making her wishes clear and then her family honoring her wish. You gave her a chance to show the direction she was going with her clinical condition. When it became clear she would not recover to a level of function she wanted, you did not apply extraordinary measures to keep her here. It is a beautiful story.
Thanks, Bill - good hearing from you, too!
Insurance reimbursement does not pay for the most important things: Doctors using their brains, and the lifesaving, life affirming therapeutic doctor patient relationship which ultimately reduces costs and use of resources.
IMO.
You are spot on
Trust is at the core. Team based care encourages planning for spontaneity. What’s the process for starting the conversation? Are there organizations in the community that are helping with filling out the paperwork?
I worked with a doctor in 2014 and forward who preferred Five Wishes.
There are reimbursement codes.
•Codes:99497forthefirst30minutes,99498foreachadditional30
minutes
• Applies to the discussion of advance directives and the completion of forms
• Can be done by the physician or “other qualified healthcare professional” in a face-to-face with the patient, family member/s or surrogate
This is an old list from 2015.
• Advance directives:
– https://www.medicare.gov/manage-your-health/advance-directives/advance-directives-and-
long-term-care.html
• Hospice care:
– https://www.medicare.gov/coverage/hospiceand-respite-care.html
• Respecting Choices” Gundersen Health,Wisconsin – www.gundersenhealth.org\respectingchoices
• The Conversation Project www.theconverationproject.org The Starter Kit is available on line
• The Five Wishes www.agingwithdignity.org
• MOST form http://coloradoadvancedirectives.com/wp-content/uploads/2014/07/1-MOST-Form-FINAL-015.pdf
This is all from a TMF Health Quality Institute presentation in 2015. More to share on process.
Thanks Christy. That is very detailed and helpful. You are correct. It takes trust and time to have these conversations
Well done
Contact this site. Www.Help4srs.org
They will send 2 free end of life booklets per address, with additional copies for a few dollars. H.E.L.P.
Over the years I have bought many H.E.L.P. booklets to help friends begin to consider what they want their end of life to look like. Written in completely plain English asking very simple questions it helps you consider your quality of life. it's completely understandable and it's a good thing to do with a loved one before the end-of-life.I suggest everyone get a copy and go through it And answer the very simple questions. Your loved ones will be grateful that you did it.
Great to hear from you and that is an excellent suggestion.
Good to address this issue, Bill. Thank you. Americans have, in general, a terrible relationship with death. We glorify it, we fear it, we deny it, we see it as “other,” but we don’t help people with the experience. Which, after all, is universal. And most Americans don’t trust health care “providers,” and don’t have a personal physician whom they trust. So most of us are abandoned in this important time of need for support. Fortunately, there are thousands of hospice workers and volunteers helping and providing this support. But not enough, and with not enough funding or community backing. It’s a distressing situation and one that doesn’t look as though change is coming to it. Best regards, David
Thanks David. That is a great summation. You are right. Too many people don't get enough support. Internists spend a lot of time with dying people They always appreciated being with their family and hospice support.