Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why you should have your end-of-life discussion now

Gene Uzawa Dorio, MD
Conditions
May 26, 2015
Share
Tweet
Share

Draping a shroud of 30’s Depression on any dust bowl child can thicken the skin, so my 88-year-old patient learned to be fiercely independent with a “talk to the hand” attitude, and “don’t get in my way” personality.  Even after her husband passed away, she remained autonomous traveling and golfing in her social circuit.

Living life as a smoker was always a threat to her health, and this year became a challenge as she continued to make it through hospitalizations, and return home.

With each admission, she advised me “I want everything done.”  An advanced health care directive was presented, designees were made should she not be mentally able to make health care decisions, and details of her full code status were always on the medical chart.

Entering her hospital room, I found her respirations labored, so a code blue was called placing a breathing tube.  I was surprised by the staff response as the surrounding talk was, “Why are we coding this 88 year old?”, and “She should be a DNR!”

Someone then commented “she said she wanted to die,” and apparently a staff member was calling the health care designee to change the code status.  This is the duty of her physician, and I, therefore, advised everyone the wishes she had detailed to me for over a decade.

Unfortunately, this staff reaction is pervasive throughout all hospital units, and especially applied to elder senior patients.  Most susceptible are those who have no end-of-life documentation, or when the admitting physician has not had this important discussion with the patient or family.

Because business has taken over medicine, one of the easy ways to lessen costs is to expedite hospitalized patients to end-of-life care.  Hospitals are paid a lump sum by Medicare, so they avoid costly intensive care units, decrease tests, and reduce patient length of stay; HMOs are able to financially wash their hands of their medical obligations; hospice care organizations enhance their business; and skilled nursing facilities (nursing homes) are now the final destination of the Greatest Generation.

Who makes health care decisions?  It should be the patient based on their personal hopes and needs, and the physician meshed with the realities of modern medicine.  Eighty percent of my geriatric patients have made up their minds and are DNR (do not resuscitate) and want no heroic measures taken should they stop breathing or their heart stops.  The other twenty percent are full code, or have specific interpretations of what they want at end-of-life.

I have this discussion with one hundred percent of my patients or families.  Since we now have a drive-thru medicine culture, my physician colleagues do not have time to have a conversation. Hence, it is up to the patient and family to assure end-of-life decision-making is made far before an emergency develops.  Over the past several years, the media has promoted this information, but simultaneously business interests have exerted pressure on health care personnel to move hospitalized patients rapidly into hospice care.

Here is advice that might allow you to make rational emergent decisions in your best interest:

  • Have a discussion now with your family or friends what you want concerning end-of-life decisions.
  • As memory problems sometimes comes with aging, have this discussion while you are mentally capable.
  • Read and formally fill out your decisions into advanced health care directives, durable power of attorney, POLST, living wills, five wishes, or other available forms.
  • Re-evaluate these documented decisions as you age, reflective of your health and quality of life.
  • Find a constant trusting physician who will facilitate your decision-making.
  • Have the documents of what you want readily available should you be hospitalized, and make sure you or your family informs the admitting physician and hospital.
  • Be leery of business tactics, even in a hospital or from a doctor, forcing you to make a quick or uncomfortable decision concerning your care especially if it is directed toward hospice or a nursing home.
  • This might be more difficult:  Be careful what you say, as literally for some reason, when hospital personnel hear “I want to die” (even if you are in pain or duress), they push the “hospice button” and a palliative care team or hospice group attempts to activate their services.  (Palliative and hospice are an invaluable part of end-of-life care, but when used as a money-saving tactic by business under the guise of compassionate care, can be a misplaced tool applied too early to the detriment of you or your loved one.)

Throughout health care, medical decisions are being made by insurance companies, hospitals, and HMOs, instead of your doctor.  But open discussions and early decision-making will allow you to avoid business tactics now being used against elder seniors.

For my patient, the breathing tube eventually was removed, and arrangements were being made for her to go home.  Just before discharge, she stopped breathing.  Without pain or discomfort, and at the behest of her health care designee, she passed away.

This is what she would have wanted.

ADVERTISEMENT

Gene Uzawa Dorio is an internal medicine physician.

Prev

Want to become a doctor? Ask yourself the following questions.

May 26, 2015 Kevin 53
…
Next

A high school physical that shook this student to the core

May 26, 2015 Kevin 11
…

Tagged as: Palliative Care

Post navigation

< Previous Post
Want to become a doctor? Ask yourself the following questions.
Next Post >
A high school physical that shook this student to the core

ADVERTISEMENT

More by Gene Uzawa Dorio, MD

  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • Pope Francis dies at 88. What his care reveals about America’s failing hospitals.

    Gene Uzawa Dorio, MD
  • When saving lives leads to losing your own

    Gene Uzawa Dorio, MD

More in Conditions

  • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

    William J. Bannon IV
  • Facing terminal cancer as a doctor and mother

    Kelly Curtin-Hallinan, DO
  • Why doctors must stop ignoring unintentional weight loss in patients with obesity

    Samantha Malley, FNP-C
  • Why hospitals are quietly capping top doctors’ pay

    Dennis Hursh, Esq
  • Why point-of-care ultrasound belongs in emergency department triage

    Resa E. Lewiss, MD and Courtney M. Smalley, MD
  • Why PSA levels alone shouldn’t define your prostate cancer risk

    Martina Ambardjieva, MD, PhD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why the heart of medicine is more than science

      Ryan Nadelson, MD | Physician
    • How Ukrainian doctors kept diabetes care alive during the war

      Dr. Daryna Bahriy | Physician
    • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

      Harvey Castro, MD, MBA | Tech
    • How women physicians can go from burnout to thriving

      Diane W. Shannon, MD, MPH | Physician
    • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

      William J. Bannon IV | Conditions
    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why the heart of medicine is more than science

      Ryan Nadelson, MD | Physician
    • How Ukrainian doctors kept diabetes care alive during the war

      Dr. Daryna Bahriy | Physician
    • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

      Harvey Castro, MD, MBA | Tech
    • How women physicians can go from burnout to thriving

      Diane W. Shannon, MD, MPH | Physician
    • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

      William J. Bannon IV | Conditions
    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why you should have your end-of-life discussion now
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...