Has Your Doctor Talked To You About EOLC?

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Has your doctor talked to you about EOLC? End-of-life care?

No? Then maybe it’s time you requested it.

Research suggests that most doctors don’t initiate end-of-life care conversations with their patients. Some find such conversations too uncomfortable or complex and usually there isn’t enough time when appointments are generally only 15–20 minutes or less. Others — like many of us — consider death to be a kind of medical failure. Doctors, after all, are in the business of prolonging life not talking about how it will end.

But we need to be having these conversations with our doctors for the sake of ourselves and our families, the health care system, and the medical professionals themselves.

In a recent article in the Medical Economics Journal (September 2022), Dr. Dan Morhaim offers 5 compelling reasons why opening up end-of-life care discussions between doctors and patients is important:1

1. Completing an Advance Care Plan ensures that your wishes help direct the kind of health care you receive as well as avoid the treatments you do not want. Thus, your health care is personalized in a way that respects your choices and values.
2. We are living longer and want more control over the quality of our lives as we get older. Doctors can help us prepare our Advance Directives and inform us of current treatments available, support services like care in the community, personal assistants, hospices and palliative care. COVID made us all too aware of inequalities in the healthcare system: encouraging us to consider our Advance Directives early in life can ensure that those inequalities (in communities of colour, for example) are minimized.
3. Knowing what a patient wants or doesn’t want can help reduce healthcare costs and waste. As Dr. Morhaim points out, “increased health awareness, advances in diagnosis and treatment, and evolution of pharmaceuticals” are resulting in longer life expectancy. While those advances are to be welcomed, they are accompanied by rising care and medical costs. Hospitals and patients alike are struggling to meet those costs. Of the nearly $900 billion spent on health care in the United States, one-third of that budget goes to end-of-life care. Yet, more and more people are choosing to die at home or in hospice, choices that are much less expensive than dying in a hospital. While such choices are not possible for everyone, acknowledging these more personal choices could save the health care system substantial costs.
4. Having end-of-life care conversations with patients can be rewarding for doctors. Dr. Morhaim reports that doctors in the United States can now be reimbursed for creating time for end-of-life care conversations with their patients. Knowing this is all the more reason why patients should be requesting appointments to talk about their advance care plans. That’s a win for the patient and a win for the physician. You are not inconveniencing the doctor by requesting such an appointment.
5. This last reason is probably more concerning for the physician than the patient. In the United States, there is a growing fear in the medical community of litigation over “wrongful death” claims. This can come about when a doctor is alleged to have ignored or not sought out a patient’s legally documented wishes. (Note: Advance Care Planning documents are not legal in all states, provinces, or countries. Check with your local laws or ask your End-of-Life Planning Facilitator.) Thus, it makes sense for the doctor and patient to have an open, honest conversation about the kind of health care and treatment the patient would want during the end-of-life transition.

As Dr. Morhaim writes, “If these five reasons don’t make a strong enough case for physicians to engage with their patients in advance care planning, here’s one more: it is simply the right thing to do” (p. 38).

I agree. As a licensed Before I Go Solutions End-of-Life Planning Facilitator, I support such conversations and help people prepare for them so they feel more comfortable and confident about talking with their physicians about their end-of-life wishes.

To arrange a free 20-minute conversation to discuss your needs, email michael@myendoflifeplan.ca or go to https://www.myendoflifeplan.ca/book-a-session.

1. “5 reasons why your patients need advance care plans”, Dan Morhaim, M.D., Medical Economics Journal (September 2022) Volume 99, Issue 9, p. 38.