Few Seniors Have Advance Directives, Yet Doctors Don’t Like It When They Do

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In MinnPost, Susan Perry discusses a JAMA Internal Medicine study that found that, within 48 hours of being hospitalized, almost half of adults aged 65 or older needed someone else to help them make one or more decisions, while only 25% had documents prepared to guide what those decisions should be and who should make them. Yet when seniors do have advance directives, doctors often don’t like it.

Common decisions involved resuscitation orders, tests, operations and discharge planning. MinnPost also provides an extensive interview with the lead author, Indiana University School of Medicine’s Dr. Alexia Torke. She said the study found “a very large middle group” where “patients have their mental capacity wax and wane” while in hospital. “So they may be able to participate in a decision one day, and then the next day they become confused and can’t participate… A second possibility is that the patient may have some cognitive impairment and participates in the decision, but the physician really doesn’t think the patient has the ability to make the decision independently. So, it turns out that a kind of three-way communication — one in which there’s a patient, a surrogate decision-maker and a clinician — is actually pretty common. Of course, that kind of communication is even more complicated because there are three people involved.”

Asked if doctors were comfortable in such situations, Torke said, “No. In fact, some of my prior research focused on physician experiences with surrogates. Physicians are not really trained routinely at how to communicate with family members, and they are often uncomfortable [doing so]. I think that’s because communication and decision-making [with surrogates] are more complicated.”

Late-in-life care: the stressful, complicated world of surrogate decision-makers (MinnPost, August 20, 2014)

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6 COMMENTS

  1. It strikes me, the medical community does not appropriately value human life. My dad, and a 94 year old pastor friend of ours, happened to be in the same hospital and coridor at the same time. After about three days in the hospital, both men uncharacteristically suffered from extremely low blood pressure on the exact same day, at the exact same time. This ended up killing my father.

    Was it actually a medication error that killed my dad? I think I likely was. Was it intentional, probably not. Medical “mistakes” are at least the third leading cause of deaths in America. But since the medical community is not held legally accountable for the deaths they cause, they don’t have any reason to try and improve services. My dad probably would have been better off if the paramedics who took him to the hospital for losing his balance, had just put him in his own bed instead. It’s sad mainstream medicine has gotten so bad.

    • I used to be an RN-I made mistakes…the number of patients we were assigned, the amount of paperwork we were required to do…the lack of ‘time’ to learn about new treatments/drugs we were suppose to administer…

      I am no longer a nurse. I would go home every single night with my heart pounding-the dangerous situations I had to juggle was more than I could take…some people thrive on this kind of stress…good for them,

      The administration makes these decisions based on acuity (numbers assigned to various textbook ‘conditons’) but fails to account for the different on the ground conditions on the ward…always trying to squeeze a buck out of a situation, and not really interested in the wellbeing of ‘the consumers’.

      I have had my life saved twice now by emergency medicine…I now believe it to be the only useful kind.

      • Human being.

        I’m glad emergency medicine successfully saved you twice, but it is not a ringing endorsement for the medical community when the nurses, like yourself, state ER medicine is the “only useful kind” of medicine.

        People make mistakes, because we’re all just human. My issue is that the medical community makes an inordinately large number of deadly, but preventable, errors. And many times, as in my own personal story, rather than confessing to their easily recognized iatrogenesis, they cover up it up with complex iatrogenesis, then have the psychiatric practitioners defame and poison people. And because the doctors have a wall of silence, that leaves the patient to research medicine, to prove the medical “mistakes” herself.

        That’s deplorably unethical behavior by a profession that believes it deserves respect. It’s called the “dirty little secret of the two original educated professions,” because it is wrong.

        The hospital that took “care” of my father for the last three weeks of his life charged his health insurance company over half a million dollars for the “care.” Do you think that was just payment for services rendered? Or has the mainstream medical community gotten too greedy, and is it right to take over half a million dollars for “care” that killed a man?

        • That’s unfortunately a psychologically understandable thing – people who do mistakes, especially grave ones, tend to protect themselves from consequences. That’s why there have to be systems in place that don’t leave it up to individual ethics of a doctor.
          One more thing that comes to my mind is the incentives that doctors have and also the amount of work. Same with nurses – there’s going to be a difference in quality of care and mistakes made if there are 2 nurses or 10 nurses caring for the same number of patients. Unfortunately the trend is to count costs…