Physicians and End-of-Life Conversations

Before funerals at funeral homes in Greenbelt, MD, you may know that you should do advance care planning to make sure your medical wishes are known, that you have a medical power of attorney in place, and that you have a living will in place.

You know that one day you will die. You could be in an accident and die suddenly. Or you could be diagnosed with a terminal illness. Or you could simply die of old age. Regardless, death will come.

Even though you know you should prepare for its inevitability, you may feel like it’s too morbid to think about, talk about, or do anything about. You may think that if you do advance care planning that it’s opening your front door for death to walk in.

While these tend to be how many of us look at advance care planning, we would like to think that physicians – who deal with life and death every day – would be more assertive and more willing to talk with us, their patients, about it.

The reality is, though, that physicians are just as reluctant to discuss advance care planning with their patients – even the patients they suspect or know will be dead within a year.

Why?

One reason is because of the goal of American health care, which is to prolong life. If you’re busy working to prolong lives, then there’s no need to talk about the possibility of the end of life and how that should look. Some doctors have the same fear that their patients do: if they bring up the subject of advance care planning, then their patients will think they’ve given up on them and they know something about their health that they are keeping from their patients.

Because medicine in the United States is focused on keeping people alive for as long as is possible, instruction about how to have advance care planning conversations with patients is not a part of medical school curriculum, nor is it a part of residency programs, where medical students are interacting directly with patients under the guidance and training of doctors and surgeons.

Another reason that many physicians don’t have advance care planning discussions is because they simply don’t have the time. As medicine in America has moved toward the corporate for-profit model, so has its billing model. Time is money.

Much like other professions, such as law and accounting, that use a billing-for-time structure, medicine has now become attached to the clock instead attached to the patient and the patient’s needs. Most physicians have about 15 minutes to spend with each patient. Much of their compensation is tied to how many patients they can see per day and how much of their time can be billed to insurance companies and Medicaid and Medicare.

Fifteen minutes is not enough time to have advance care planning conversations with patients. A physician would have only enough time to bring the subject up and then move on to the next patient. Physicians understand the worry and the anxiety this would give their patients (i.e., “Why did my doctor want to talk about that? Have I got some kind of terminal illness? Am I dying?” would be the logical reaction), so they simply don’t mention it at all.

Advance care planning is important, however, because it gives you control over how you want your life managed medically at the end of your life. It lets you specify how you want the end of your life to look, from a medical standpoint. And it gives you control over how you want your funeral to be.

If you’d like to know about funerals at funeral homes in Greenbelt, MD, you can talk with our knowledgeable team at Donald V. Borgwardt Funeral Home, P.A. You can visit our funeral home at 4400 Powder Mill Rd., Beltsville, MD, 20705, or you can call us today at (301) 937-1707.