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Doctors Weigh in on the End-of-Life Conversation

By Katie Wingo

The end-of-life conversation is rooted in empowerment through education, and doctors play a key role in C&C’s mission to help Americans get the care they want. We are gratified to see a trend in today’s news: doctors, more and more, are contributing to the end-of-life care and planning conversation in a big way through opinion pieces and interviews with major outlets beyond the medical beat.

From criticism of the healthcare system to introspective pieces on practice, end-of-life issues are increasingly front and center of health and wellness sections in publications like The New York Times and the Washington Post.

Oncologist Ezekiel J. Emanuel contributes to the New York Times’ Sunday Review with his essay about seniority in hospitals and the rise of compassionate care training in a younger crop of surgeons. He makes the case that those younger surgeons may provide better care than their senior counterparts who come from the school of aggressive treatment. He cites a study that found there are higher mortality rates in patients with life threatening heart problems when senior cardiologists treat them. One possible explanation for this counterintuitive finding is that seasoned physicians may treat patients too aggressively.

Doctors are weighing in on the Centers for Medicare and Medicaid’s (CMS) decision to cover advanced care planning by reimbursing doctors for discussing it with their patients. Jennifer Brokaw, founder of the medical advocacy group Good Medicine and former emergency physician, writes a piece featured on TIME.com about how the CMS plan is a good step, but falls short. She argues that the plan addresses incentive (paying doctors), but the amount isn’t enough to cover the meaningful and in-depth conversations needed to adequately address the complex task of end-of-life planning. She also worries that doctors are not adequately trained to provide this very important service to their aging patients.

Emergency room doctor Zaid Obermeyer is interviewed for a piece in the online magazine STAT and expresses his concern for the lack of realism and candor in caring for patients. Doctors, taught to practice through optimism and aggressive treatment, aren’t being forthright about the gravity of their patients’ illnesses. The consequence is a lack of planning on the part of patients and families, which can result in crazed end-of-life planning in the emergency room when emotions are high. Dr. Obermeyer is working to develop a new method to help physicians calculate their patient’s rate of decline to encourage planning – before they reach the emergency room.