Do you have an advance directive to inform your family what to do if you become incapacitated by a medical condition?
Does your family know what you want when you approach the end of life?
Should I have one?
If your patients ask these questions, you should be ready with answers, according to AMA policy adopted last year, which also calls on the AMA to promote National Healthcare Decisions Day, which is marked each April 16 and is dedicated to encouraging discussion of advance care planning and advance directives.
Amid the COVID-19 pandemic, physicians and medical students nationwide have spread the word on social media, in their practices, their health care organizations and with their patients about their choice to get vaccinated to protect themselves, their families and their communities. Similarly, a great way to show patients the value of advance care planning is for physicians to be able to talk about the steps they’ve taken on their own advance directives.
George M. Lange, MD, conducts training for physicians, sponsored by the Wisconsin Medical Society, teaching them how to prepare their own advance directives that detail their wishes should they not be able to participate in directing their own care. The training program also teaches physicians how to advise patients on getting guidance to prepare their own advance directives.
“Physicians should do their own advance directives for several reasons,” said Dr. Lange, a retired internist and geriatrician in Milwaukee, Wisconsin. “First, they need a directive so they can get the care they want at a time when they are not able to articulate what they want. Second, they need to protect the people who care about them from the trauma of making health care decisions for you when they don’t know what you want.”
Why advance care planning matters
If you don’t have an advance directive, “it’s much worse for your family if they don’t know what their family member wants at that time of life,” he said. “Your directive means that your family will not have to face any conflict between themselves over the decision they need to make. They all know what those decisions are.”
A physician’s own advance directive sets the tone for discussion with their patients about why they should complete their directives to protect themselves and their families, Dr. Lange noted.
“Most state medical societies have forms available that can prepare individuals to verbalize their wishes and identify the agent who will follow your directives when needed,” he said.
Using appropriate documentation obligates the agent to follow your directive and empowers that person to do what you direct when the time comes, Dr. Lange noted. The Institute for Healthcare Improvement’s The Conversation Project also promotes National Healthcare Decisions Day and features a list of state-specific links to information about advance directives.
Learn more about how to help patients move forward with advance directives by making use of the AMA STEPS Forward™ toolkit, “End-of-Life Care: Facilitate Early Discussions with Patients.”
More advice from the AMA
In addition to the above, the AMA policy also encourages:
- Practicing physicians to voluntarily publicize the fact of having executed our own advance directives, and to share readily available educational materials regarding the importance and components of advance directives in offices and on practice websites, as a way of starting the conversation with patients and families.
- All physicians of relevant specialties providing primary or advanced illness care to include advance care planning as a routine part of their patient care protocols when indicated, including advance directive documentation in patients’ medical records—including electronic medical records—as a suggested standard health maintenance practice.
Learn what the AMA Code of Medical Ethics says about advance directives and, more broadly, about caring for patients at the end of life.
Dr. Lange, an AMA delegate for the Wisconsin Medical Society, said advanced directives can be easily facilitated using electronic medical records that can alert medical teams of the availability of directives that have been added to the records.
He also suggested that the directives be updated every 10 years to account for the identification of new diseases and disabilities. Physicians who would like to learn more about advance care planning and advance directives are invited to email Dr. Lange.
The AMA Senior Physicians Section gives voice to, and advocates for, issues that affect physicians 65 and older, both active and retired.
