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End-of-Life Communication and Care: A Struggle Most Physicians Encounter

Ali Katz


Just as it is difficult for many of us to talk about our ultimate death, it is also difficult for doctors to talk about this eventuality with their patients. Most doctors did not specialize in palliative or end-of-life care, yet they are often called upon to have these tough discussions with patients.

You can make it far easier for your doctor, and for your family, by making your wishes known and documenting your choices in a properly drafted Advance Medical Directive, along with naming the people you want making decisions for you if you cannot. And, by ensuring you have updated your plan to include HIPAA releases to ensure your loved ones can access your medical records, if necessary.

Earlier this year Medicare began reimbursing doctors who engage in conversations with their patients about end-of-life care and choices. It’s a significant improvement in patient care while providing a financial incentive for doctors to have these conversations. Thirty minutes is reimbursable at an $80 rate, and an additional $75 may be billed for a second 30-minutes.

Many, however, doubt that doctors are equipped to handle this responsibility. In fact, the Chief Academic Officer for the Association of American Medical Colleges doesn’t believe the “medical profession is totally up to speed and ready to have these conversations.”

Dr. Susan Block of the Serious Illness Care Program at Ariadne Labs agrees, explaining that “[t]his conversation is at the intersection of two topics that medical schools have by and large avoided—end-of-life care and communication.”

Dr. Block is also concerned that not handling these types of conversations well may be worse than not having them at all. She suggests the use of an Ariadne Lab publication designed to help doctors know the right issues to raise with patients. You can access the Serious Illness Conversation Guide online if you would like to be more informed about how to talk these issues through with members of your own family.

It is always hard to acknowledge our mortality but doing so can bring significant peace of mind. We are here to help, and make it easy for you to choose to do the right thing by the people you love, and by your doctors as well.