Friday, April 13, 2012
Family Medicine Activist: End of Life Discussions
Three patients over 80 years old were discussing end of life situations with me in recent months. They, like many other seniors, are looking at their potential transition to "the hereafter". They worry that it won't go well. Loss of control is one of their concerns. They have a living will and expect that it will protect them near the end of life. Each has a daughter who knows of the living will and has health care power of attorney if my patient is incapacitated.
The Family Physician often has to introduce a discussion about the use of the living will and the DNRCC form during an appointment intended for a different purpose. The patient does not schedule a separate appointment for this discussion, in spite of its extreme importance, ever. There is no mechanism to be paid for the service. We in the medical profession and patients and their families aren't yet effective enough to convince Congress to support payment for a focused visit for this purpose-advanced directives, aka end of life discussion.
Medicare includes hints about end of life discussion, but does not pay doctors for the service. "It remains legal for doctors to talk with patients during the annual Medicare visits; it's just that they can't be specifically paid for that discussion"....from Elder Law Answers web site. So we're OK to have a very important discussion, but not able to get paid for the service, adding some frustration to intentions about end of life discussions.
Another form they may need here in Ohio, now or later, is the Do Not Resuscitate Comfort Care form. I like the simplicity and the list on page 2 of the form. What do you think? What happens in your state?
Ohio Do Not Resuscitate Forms