Sunday, April 15, 2018

Do The Hospital Doctors See Your Advance Directives?

Of late it seems to me that we have seen a lot of articles dealing with issues regarding end of life wishes.   The New York Times ran an article in late March about doctors actually seeing a patient's advance directive.  You’ve Detailed Your Last Wishes, but Doctors May Not See Them is written by a doctor who summarizes first-hand experiences in a hospital with one patient in the ER who "had done everything we could have asked. He’d been brave enough to talk with his doctors about his cancer and acknowledge that time was short. He had designated a health care proxy. But there he was, surrounded by strangers, the intubation he never would have wanted looming and the record of that conversation buried in his electronic record." 

Here's how the doctor described the problem, as "not about individuals, but instead about a system that doesn’t sufficiently protect patients from getting care they do not want."  The issue it seems is documenting the info or the ability to retrieve the info in the chart.

This doctor "delved into the unexpectedly interesting world of advance care planning and electronic health records, interviewing clinicians with on-the-ground experience recording and retrieving these conversations and representatives from the companies behind some of the most widely used electronic records."  The stories shared are quite interesting and highlights the issues that arise without a national standard.

Here are some suggestions the author included in the article:

What could really make a meaningful difference, I heard time and time again, is standards for sharing, or “interoperability” across all electronic records that would benefit every patient, everywhere. At least, all related advance care planning documentation should be in one place in the medical record and accessible with one simple click of the mouse. Beyond that, maybe all health systems could require identification of a health care proxy for all patients, so we would know who should make decisions if the patient can’t. Maybe patients should be able to access their health records through a patient-facing interface, send in their own directives, or even update related notes. Ideally, the electronic record isn’t just a clunky online version of a paper chart but actually a tool to help us do our jobs better.

Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink


This is exactly why we need to empower patients and agents at points of entry into the healthcare system.
Through a process called my informed decision on video or MIDEO we are able to make sure that patient’s advanced directive‘s are presented and understood by both patients and medical providers equally

Posted by: Ferdinando Mirarchi | Apr 16, 2018 5:13:15 AM

“Seeing” is not believing
After more than three decades of litigation and legislation to affirm the rights of patients to refuse unwanted medical care and create valid “advance care directives,” the healthcare industry’s compliance rate in the United States remains low.

The article Professor Morgan cites describes several structural barriers within the industry, along with a physician’s modest suggestions for improvement. Unfortunately, those will fail to achieve the goal of having patients’ advance care directives honored.

While greater interoperability of electronic medical records, one click access and requiring a healthcare proxy may lead to improvements—in another decade or so, they will fail to achieve the goal of being honored until less publicized barriers are acknowledged and addressed.

First, unless such records are implanted into humans, as they are now in many of our nation’s pets—or tattooed on one’s body, as they were in one recent medico-legal case, they won’t be quickly or easily accessible, particularly in times of crisis or technology lapses.

Secondly, there is no penalty to a physician, hospital or other care provider for refusing to honor such requests, but all three groups are now frequently sued for under treating patients. Given that reality, what would you do?

Thirdly, to compound the problem, there are great economic incentives in the U.S. for all healthcare providers to provide as much care as they can, since that is how they are largely paid.

Finally, a very large percentage of American hospitals and other care facilities are owned by religious organizations which expressly cannot and will not follow some advance care directives.

Posted by: Ron Hammerle | Apr 16, 2018 11:14:05 AM

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