When you work with patients/families who are trying to make difficult decisions, it is easy to slip into that reverie of “If they only knew what we know…”. We think that if only then we wouldn’t have to have this difficult discussion, they could make these decisions so much easier, we would all be out of this room.  If only it was that easy.

As in so many things the reality and our beliefs are at odds.  We think that we consume fewer calories, are more active than we are, and make rational decisions about healthcare. We don’t.  Colleagues here at University Colorado Denver have just published an article in the Journal of the American Geriatric Society that compared healthcare utilization to non-physicians in the last year of life.

Data showed the proportion of physicians with at least one ICU stay in the final six months of life was about the same as for non-physicians, according to a study in the Journal of the American Geriatric Society. The study found that “the mean number of ICU days in the final six months and one month of life was slightly higher for physicians, and that more physicians were enrolled in hospice care and received hospice services for an average of 2.4 days longer than non-physicians.”

Thinking with the heart

So, it is just not life and work experience. Patients and families need help expressing their goals of care, and then they need our experience and our expertise to choose wisely. It takes time, and it takes practice to guide patients and families.  When the discussion is done and decisions are being made, sometimes I wonder, “Why are we doing this?  What are we hoping will be the outcome?”  In those times, I try to humbly ask that the patient and family help me understand their decision. Most of the time, it is not a lack of understanding, but as a family member told me once, “We hear, and we understand. However, this is a heart decision and not just a head decision.”  Together, we committed to the heart plan knowing that we would almost certainly be back to make a head decision in the days and weeks to come.