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It’s Time for a Serious Talk with your Doctor

This conversation is so important, powerful and hard to start.  In fact, the amount of mental anguish that will preceed this conversation reminds me of a parent preparing for the sex talk.  Today we are discussing ‘The Birds and the Bees’ talk on death and dying.  

First to set some ground rules.  

  1. Take a deep breath, relax and quiet your mind.  This is a difficult task when confronting the end of life treatment options, but try your best.  
  2. This talk honors and respects the wishes and rights of each person.  There is no ‘pulling the plug’ or ‘death panel’ mentality at work here.  
  3. A dedicated Primary Care Provider’s appointment or prolonged scheduled visit must set aside all the other daily demands to completely engage in this conversation.
  4. No one.  No one is responsible to decide for another unless they have signed a Power of Attorney or Health Surrogate (Durable Power of Attorney) over to a trusted representative.  However not deciding for yourself leaves loved ones guessing and soul searching to unravel what you want.  
  5. Signing  Advance Directive, Do Not Resuscitate and LIving Will  documents are recommended but not required at the visit.
  6. Your decision is reversible.

Nine out of ten doctors believe the end of life discussion is important but only 17% carry out this task, according to the Kaiser Foundation.   Medicare enacted a new office visit code just for this conversation.  The CPT billing code is 99497 is an optional visit for Advanced Care Planning by a Primary Care Provider, often included in your first Medicare office visit - or annual physical.  Your Doctor is required to document the time dedicated to this discussion.    

Just like the Birds and The Bees sex talk, this end of life conversation is here to prevent unintended consequences.  Most of us face this end of life discussion as we acquired several chronic conditions that slowly and steadily ate away at our abilities to perform daily tasks.  

As a medical social worker I worked in the Intensive Care Unit (ICU)  with critically ill patients often hanging on to life by a thread.  When a patient enters the ICU - that excruciating moment, the treating physician turns to the family looking for a treatment decision.  This is the moment when most families fall to pieces and fail to speak with the patient’s voice.  That’s why this conversation is crucial.  That very moment of anguish can lead to many life saving measures that prolong life - often called extraordinary means.  

REUNIONCare is designed to carry out your wishes, your life plan.  Our person centered care plan enables you to express your wishes, record that your documents are in place and shared with a trusted person.  We encourage you to equip your Circle of Care with the tools they need for your journey.  Have the talk.  For you.  


Monica Stynchula, MSW, MPH