Having A Conversation With Your Medical Team
After you finish discussing end-of-life wishes with your family, your next step is to talk with your medical team.
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Medicare compensates physicians for end-of-life dialogues with their patients. You can now schedule a talk without feeling like you're infringing on your doctor's time or enduring another expense.
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Presumably you've already filled out your advance directive. But if your medical condition becomes unstable, you need to clarify exactly what your choices mean. Now is the time to document specifics such as whether you have a preference for dying at home rather than in the hospital. Other things to include are whether or not you want to be put on a ventilator for breathing and/or a feeding tube for nourishment. You'll need to consider what the repercussions of each of these interventions might be. And most importantly, you'll need to learn the impact of removing these devices in the event of a directive submitted by you or your health care representative.
End-of-life discussions aren’t easy for a doctor or patient. For the patient, envisioning one’s end makes the conversation very personal and emotional. For a doctor, this can be an uncomfortable admission now that their medical bag of options is empty. Some physicians are skilled and confident in talking about end-of-life and handle such interviews with sensitivity and compassion, but others are poorly trained or just more introverted, and may find themselves in over their heads. In these instances, some patients may prefer to lead the discussion themselves and remove the burden from their doctor. Often a patient is more prepared than a doctor to pose tough, personal questions that have been jotted down in advance, and to probe into ambiguous areas. Reluctant doctors would likely be relieved by the initiative of a willing patient.
Remember that both you and the doctor may be on unfamiliar ground.
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Now is the time to ask your doctor about a Physician's Order for Life Sustaining Treatment (POLST), sometimes called a Medical Order for Life Sustaining Treatment. This will give special instructions to a medical team regarding what you do or do not want done. These are not options that are filled out in advance while you're healthy (like an advance directive or living will). They are down-to-the-wire decisions that will have an immediate and possibly dramatic effect on whether you receive aggressive treatments or palliative care.
Some States require a MOLST instead of a POLST. MOLST stands for Medical Orders for Life Sustaining Treatment and acts in the exact same way as a POLST. If you are faced with the need for either of these forms, the doctor will provide the correct one. The doctor, not the patient, completes the form.
The instructions documented are mandatory for EMTs as well as hospital staff. So be sure that if you have these documents, they are in a place where they can be readily found in an emergency.
There is a lot to know about POLST forms.
If you or a family member are facing serious illness, the attached link will help you understand and sort through your options.
Here are links to two very important short and helpful videos that help clarify differences between POLST forms from DNRs or Advanced Directives:​
Review these carefully before meeting with your doctor. Documenting the treatment you want in an emergency in advance is vital to achieving your end of life wishes.