It always seems too early, until it's too late
In a letter penned by Benjamin Franklin in 1779 to French physicist Jean-Baptiste Le Roy, the Founding Father wrote “Nothing is certain except death and taxes.”
Those famous words are the reason why National Healthcare Decisions Day strategically falls during the same week that tax returns are due. It is a time when Americans are encouraged to reflect on the healthcare choices they prefer should they be faced with a serious illness.
According to Jeffrey Yee, MD, internal medicine doctor at Dignity Health, “Advance care planning helps your physician understand what is important to you.” He says, “It should be a normal conversation with your doctor at every age.” To illuminate the significance of these conversations, Dr. Yee shares a real-life story about a woman who was one of his longtime patients.
“We just had a conversation together about completing a POLST (Physician Order for Life Sustaining Treatment). I asked my patient what would happen if she had a stroke. As we talked she made clear to me what she would and would not want,” Dr. Yee explains. “She said she would not want a feeding tube or any other valiant measures. Neither one of us realized that she would actually have a stroke just two days later.”
When Dr. Yee first talked to the family about their mother’s condition they were in turmoil, arguing with each other about what should be done for her. “However,” he says, “when I explained that I had a conversation with their mom to better understand what was important to her, and that she did not want to be sustained in a state where she would not have quality of life, the family immediately became more settled. They were at ease knowing that she already made some decisions ahead of time, and that her wishes could be honored. Having that information, the family started to discuss next steps for their mom.”
Dr. Yee’s patient went home with hospice care that same day. A few days later the woman passed away in her own home surrounded by family. Her son asked another doctor at the hospital, “How did he know to have this conversation with mom.” The colleague replied, “Dr. Yee has these conversations with everyone. He talks to all of his patients about their wishes and values.”
Joanne Hatchett, a nurse practitioner at Dignity Health who works closely with Dr. Yee has her own set of stories about the importance of these discussions. She recalls a patient who was on life support. His four children were in extreme disagreement about what should be done. “There was intense conflict,” she says. “As a starting point, I asked them to tell me more about their dad. What did he love?”
Through their conversation together she learned that her patient was a Marine who loved crossword puzzles, food, and shooting beer cans from his front porch. That discussion led them into a bigger discussion about their dad’s current situation. She gently asked the family, “If your dad could speak, what would he say to you about his wishes and what he would want?” That question, according to Joanne, “led to a very productive talk with the whole family.”
Another story that Dr. Yee likes to share is about his own aunt. “She went in for surgery. Unfortunately, there were complications and then she had a major stroke,” he explains. “Even though she lived for two years after the stroke, she had repeated trips to the hospital and could only remain awake for a few minutes a day. Perhaps being that way for two years is what she would have wanted, but perhaps not. We’ll never know because she never expressed her wishes.”
Joanne and Dr. Yee both believe that advance care planning helps healthcare providers be more patient focused. “It helps us center on the things that are most important to our patients,” says Dr. Yee. Joanne explains it a different way. She says, “We plan for everything else . . . a new child, birthdays, anniversaries, graduations, careers, and retirement. We even plan for catastrophes by purchasing insurance. Why would we not plan for the end of our life?”
When asked where their passion comes from for advance care planning, Dr. Yee says, “From seeing the pain when it’s not done correctly.”