The Monday Memo
November 4th, 2019 PITT DPT STUDENTS
There is a conversation that needs to be had all across the world. It is not a pleasant conversation. For many, it can be unsettling and anxiety-inducing. It may create conflict between family members and loved ones. While this conversation is a challenging and dreaded one, it is also an extremely important one.
I am not talking about politics, religion, or climate change; I am talking about wishes for end of life care. Talking about death is extremely taboo in our culture; most of us tend to avoid the topic at all costs. But this conversation is also one of the most imperative discussions we can have with our loved ones. Think of how many horror stories you have heard, seen, or even experienced, about families having to decide what happens to their loved one who has been in an accident or has suffered such severe cognitive decline that they are no longer able to make medical decisions for themselves. How many times have you heard about families fighting over the stress these situations cause? What if I told you this could be preventable—and all it took was one conversation.
I am not here to tell you this conversation is easy. It most certainly isn’t. It is not easy to bring up this discussion elegantly, but I can give you some tips and resources to make it a little easier. Step One: fill out an Advanced Directive yourself. There is no better way to understand and gain appreciation for something than to do it yourself. You can fill out your AD at prepareforyourcare.org. Here, you can watch videos explaining what an Advanced Directive is. You also can fill out the form, identifying your medical decision maker, along with your wishes for your end of life care if you are no longer able to make decisions yourself. Step Two: Initiate the conversation with your family. Theconversationproject.org is a great resource to use, and even provides a conversation starter kit. Explain to your loved ones what the Advanced Directive is, and why it is important. Allow them some time to think about their wishes and provide them with the resources they need to understand and fill out their AD. Then, when you all are ready, have a discussion about your own preferences for your care and ask them about theirs. Step Three: Initiate this into your clinical practice. Assess if a patient is open to having the discussion and educate them about the importance of taking control over their end of life care.
As healthcare professionals, we often do not ask our own patients these difficult questions because we do not think it is our place. And that is just the problem—no one thinks that it is their place to ask, so no one does, and the cycle continues, creating more and more of a stigma about talking about death. But what if we normalized this conversation? What if we talked to our patients about their wishes for the end of their life like we talk to them about their discharge plans or their medication regimens? As Physical Therapists, we see our patients more frequently and consistently than any other healthcare provider. We know these people. We know their families. We have relationships with them. So why don’t we encourage and empower them to make these crucial decisions now, while they still have the ability? Why don’t we help ease the burden on the family that comes along with these painful decisions? Why don’t we put the power back in the patients’ hands to decide what they want? I encourage all of us to take responsibility to initiate this conversation when appropriate. All it takes is a simple, “I would like to talk to you about whether you have come up with a plan for your end of life care, and whether you have discussed it with your family. Are you open to having a conversation about this?” Having the courage to initiate these conversations with your patients and your own family can have a huge impact on a person’s final days. You can be the difference in ensuring a comfortable end to a beautiful life. Please, have the conversation.
-Kelly Conners, SPT