Advance care planning adds patient voices to medical records

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Tuesday, September 25, 2012

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Every day families have conversations about choices, large and small. What to have for dinner, when to paint the living room, where to go on vacation, which college to attend. But how about this one: what are my health care goals and preferred interventions if I have a sudden injury or illness and cannot communicate?

If that seems daunting to you now, consider just how overwhelming it would be for a loved one to have to guess at your wishes during a health crisis, a time of extreme emotional vulnerability. Families who are willing to undertake this complex discussion can offer each other a powerful tool and a source of support during uncertain times.

Ann Broderick
Ann Broderick

The result of such a discussion, an advance care plan, can now be part of your official medical record as the Johnson County community undertakes a new effort called “Honoring Your Wishes.”

This community-wide initiative seeks to create and sustain an integrated, advance care planning process where individual future health care preferences are discussed, documented, and honored by families, friends, and the health care community. Led by Jane Dohrmann of Iowa City Hospice, the collaboration involves our local hospitals, religious and spiritual leaders, nonprofit organizations, independent and assisted living communities, legal professionals, and city and county leaders.

We searched for examples of communities who were already doing this well, and all signs pointed to LaCrosse, Wis., where Dr. Bernard Hammes and colleagues had designed an advance care planning program, implemented it, and then demonstrated through robust research that it worked. This evidence of effectiveness was the crucial point for our local efforts. We did not need to reinvent the wheel.

The UI Center on Aging invites you to learn more about advance care planning at its annual Parkin Lecture at 6 p.m., Wednesday, Oct. 3. Dr. Bernard Hammes will speak on, “Having Your Own Say: Getting the Right Care When It Matters Most.”
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Here we were presented with a proven method for ensuring that the patient and family voice is heard in the medical record, so that no matter who is treating you, your medical team will clearly understand your wishes.

There is no Marcus Welby anymore. The days of a single physician caring for you and your family throughout your life have given way to an ever more complex medical system in which you will see different doctors in intensive care, emergency care, inpatient, outpatient, or clinic visits.

As a physician, I guide my patients through the huge maze of our health care system. I am also called upon to advise family members and friends as they try to navigate, and it never ceases to amaze me how many ways even I can get confused.

This only makes it all the more important to ensure that patient and family voices are heard among the medical team.

We now live within a medical system that hasn’t quite figured out how to incorporate these wishes. We physicians, honestly, have trouble having these conversations because we’re trained to do everything we can to extend life.

In fact, we ask doctors to refer their patients to the Honoring Your Wishes program, to invite patients to have a conversation with their circle of support, and to prepare an advance care plan. You and your family can meet with a trained facilitator who will guide you through a detailed discussion that results in a clear description of your wishes. That document becomes part of your medical record. You can revisit it from time to time to ensure that it represents your wishes as your health changes throughout your life or as your values and preferences change.

I’m a strong believer in leading by example. Since I knew I would be asking my colleagues to guide their patients toward this program, I undertook it myself. My husband and I met with a certified advance care planning facilitator who guided us through the conversation. Even though we’ve talked about these issues throughout our 27 years of marriage, we still surprised each other with the strength of our wishes.

We found it infinitely more manageable to have that conversation and to process that surprise during a time of strong health and solid mind. We now feel confident that we know how to care for each other and how to direct our own future caregivers.

As a doctor, I wish strongly for my patients to have that same confidence. When we have this information from the patient and family, we as physicians will walk shoulder to shoulder with you to do what is medically possible to achieve those goals.

Ann Broderick is associate professor of internal medicine in the UI Carver College of Medicine and medical director of the palliative care program at UI Hospitals and Clinics.