How is this Good?Amber Maniates Oct 13, 2020
As a Hospitalist Physician Assistant working with COVID patients during the pandemic, I have often tried to see what good may come out something so bad. Most days, it is hard to do. Very hard.
However, I have seen that we are having more difficult discussions. I am having them with my patients, my colleagues, with my family members and husband, and with friends. Some may think- “How is this good?” You see, I am a huge advocate for those difficult yet imperative conversations. The “what ifs” in medicine. Because I am also a huge advocate for people living lives that are in line with their values, beliefs, and wishes. Something I think we often don’t discuss is how a potential medical disaster and the treatment/interventions that could follow would be in line with those same values and beliefs. The hard questions: would you want artificial nutrition if you couldn’t eat? Would you want a tracheostomy if you needed one? Many people may not even know what these medical terms mean or what they could mean in relation to their lives.
According to Lynda Anderson, PhD, “Advance care planning gives us a way to have a voice, to make a choice as to what we want from the people who will make decisions for us if we are no longer able to.” Yet, according to the CDC only about 1/3 of Americans have an advance directive.
So, how does all of this relate to COVID? The Division of Hospital Medicine at the University of Colorado Hospital, where we saw many of the COVID patients in the state of Colorado during the spring, started making sure that part of our admission note on COVID patients include a medical decision maker, or Medical Durable Power of Attorney (MDPOA). In my discussions with these patients I don’t just say, “Who would make medical decisions for you if you cannot make them for yourself?” Instead, I ask patients, “Who knows you and your wishes well enough to make medical decisions that you want for yourself, if you were unable to tell us?” This seems like a simple question to some, and for others, it starts a conversation about what one’s wishes would be if things were to get worse. This is often the door that opens, leading to larger conversations.
We still have a lot of work to do with Advance Care Planning. I believe that the more we have those conversations about medical care and those potential “what-ifs” the more normalized they will become. This will lead to patients receiving medical care that is in line with their wishes. Both fortunately and unfortunately, in the time of COVID, we are starting to have more of these conversations.