6 questions every physician should ask patients

One of the single most important conversations in healthcare goes unsaid in hospitals around the country every day, leaving patients out of critical decision making.

"When people get medical care they wouldn't want if they were more informed, what that sounds like to me is a medical error," says Angelo Volandes, MD, a physician on staff at Boston-based Massachusetts General Hospital and a Harvard faculty member. Dr. Volandes believes every patient needs to discuss death and preferences for end-of-life care with his or her physician.

"People flip out if a doctor amputates the wrong body part. Nobody flips out when a patient who didn't want to die in the hospital dies in the hospital with a tube in every orifice and in pain. It's time to call it out for what it is: It's a medical error."

In his recent book entitled, "The Conversation: A Revolutionary Plan for End-of-Life Care," Dr. Volandes reroutes the discussion about what he calls "modern death." While most hospitals and health systems focus on the high costs of medical interventions surrounding hospital deaths, it's critical to recognize that most of this care is unwanted, he says. Nearly 80 percent of Americans would prefer to spend their last few months at home among family and friends, yet just 24 percent of Americans over age 65 die at home, according to the text.

Through seven vignettes of seven patients facing death, including his father, Dr. Volandes aims to show patients how to take control of their end-of-life care.

But first, physicians have to give them control.

"Right now, doctors are still king or queen and patients are at a loss for how to navigate," says Dr. Volandes. The physician's role is to prioritize the conversation and provide patients with the tools they need to openly discuss their options with family, friends and various healthcare providers.

He has found one of the best ways to educate patients about their options is through videos, and Dr. Volandes even cofounded a nonprofit called Advanced Care Planning Decisions that produces patient support videos. Starting with a video flips the power back to the patient, he says. It ensures patients receive standardized, straightforward information and prepares them to think about their preferences.

Dr. Volandes recommends starting the conversation with the following questions.

1. What kinds of things are important to you in your life?

2. If you were not able to do the activities you enjoy, are there any medical treatments that would be too much?

3. What fears do you have about getting sick or medical care?

4. Do you have any spiritual, religious, philosophical or cultural beliefs that guide you when you make decisions?

5. If you had to choose between living longer or having a higher quality of life, which would you pick?

6. How important is it for you to be at home when you die?

"It's a tough subject, but if you can learn how to do brain surgery, you can learn to have this conversation," he says.

"My one piece of advice is to remember, just as you ask about medical history and allergies, you need to also ask about the patient's preference for end-of-life care. Not to do so is disrespectful."


More articles on integration and physician issues:

3 in 5 physicians report barriers to make cancer referrals
Nearly 1 in 5 insured Americans avoid seeing physicians because of cost
Physician shortage twice as severe in Hawaii

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars