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

The elephant in the room: end-of-life discussion with patients

Bernadette Hee, MD
Physician
September 26, 2022
Share
Tweet
Share

I have been at my current hospital for 12-plus years now. Like many of you, I have gotten to know some of my patients very well. I have known some of them since I first started out here. We talk about my dogs and cows, our newest grandkids, and politics if we feel adventurous. This is an extraordinary relationship built on the intangible magic generated over time, known as rapport and founded on trust.

As time and disease take their inevitable toll, our patients become frailer. Their thoughts and ours inevitably turn to the tough decision: what would they want to be done in the event of a cardiac or pulmonary arrest?

We all took an oath. Above all, do no harm. We have all learned that there are far worse things than death. There is a difference between life and quality of life. As we know, the contrast can sometimes be painfully glaring. Unfortunately, a discussion about end-of-life decisions is something that no one can elude forever. At some point, death comes for us all.

To the general public, the concept of DNR is surrounded by a veritable fog of misinformation. Their impression of the medical field is colored by the often unrealistic portrayals in Hollywood. Many times, patients hear the acronym DNR and incorrectly assume that they will receive NO care. Often, comfort measures are what patients envision when they think of DNR. This is a far more common misconception our patients hold about DNR status than we realize.

When patients are reassured that they will still receive the same level of care save that they will not undergo CPR, defibrillation, or intubation, there is often an outpouring of profound relief. Once the distinction is explained, patients then feel empowered. With encouragement, patients then feel free to ask questions and make their own informed decisions.

I have garnered somewhat of a reputation in my hospital. As a general rule, if they’re open to the discussion, I ask my patients with end-stage COPD, metastatic cancer, severe pulmonary fibrosis, severe pulmonary hypertension, terminal cardiomyopathy, or ALS if they want heroic measures or wish to pass peacefully.

I try to have these difficult discussions and decisions in the outpatient setting whenever possible. I think this should be addressed by a caregiver well-versed with the details of their condition and prognosis — they have established trust and rapport.

This is a complicated discussion for everyone involved, but I feel this is a sacred duty we owe to our patients. Our patients deserve to have a familiar, trusted face to discuss the long-term ramifications of their disease, explain what options are available, and help them decide on their end-of-life choices. Most importantly, we must ensure they are comfortable with whatever choice they make.

How often have you had to discuss end-of-life issues with someone in the hospital, and it is the first time you have met them? In these instances, we have not had the luxury of time to develop the rapport that we have developed with our longtime patients in the office. The unsurprising and unmistakable deer-in-the-headlights look on patients’ faces is our failing. It is a glaring omission we should do our level best to rectify. If we avoid addressing this important issue, we are negligent in addressing a critical component of our patient’s care. We are compounding the problem by just passing the responsibility onto someone else.

It goes without saying that the off-putting DNR discussion is inherently painful for everyone involved. That being said, it should be an integral part of treatment plans for severe diseases. By having these talks, we will know and be able to honor our patients’ wishes.

Medicine is not just a job; it is a calling.

To be worthy of the trust our patients’ place in us, we cannot shirk this duty. It may very well be the last and best service we can provide for our patients and one we owe them.

Bernadette Hee is a pulmonary-critical care physician and is the author of Kairn (Mates of the Alliance Book 1). She can be reached on Twitter @MatesofAlliance and Instagram @matesofthealliance.

ADVERTISEMENT

Image credit: Shutterstock.com
Prev

If you can't connect the issues, think connective tissues [PODCAST]

September 25, 2022 Kevin 0
…
Next

The desire to be challenged is one of the most important aspects of an effective doctor

September 26, 2022 Kevin 1
…

Tagged as: Palliative Care, Primary Care

Post navigation

< Previous Post
If you can't connect the issues, think connective tissues [PODCAST]
Next Post >
The desire to be challenged is one of the most important aspects of an effective doctor

ADVERTISEMENT

More by Bernadette Hee, MD

  • Coping mechanisms for medical professionals

    Bernadette Hee, MD

Related Posts

  • Primary care makes a difference for patients and the nation

    Glen R. Stream, MD
  • How our health care system traumatizes patients

    Linda Girgis, MD
  • Do uninsured patients receive more unnecessary care?

    Peter Ubel, MD
  • To fix health care, ask patients to change their understanding of how a health care system should work

    Richard Young, MD
  • Physicians and patients must work together to improve health care

    Michele Luckenbaugh
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD

More in Physician

  • Why more doctors are choosing direct care over traditional health care

    Grace Torres-Hodges, DPM, MBA
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • 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
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [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

Leave a Comment

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
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [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

Leave a Comment

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

Loading Comments...