How to Talk to Your Doctor

Let Your Doctor Know What Your Wishes Are

Doctors are not exempt from the difficulties of dealing with death and dying. However, as your primary healthcare provider, your physician must know what your wishes are for end-of-life care.

The best time to discuss end-of-life issues is well before death is imminent. Upon admission to a hospital, the Patient Self-Determination Act of 1990 requires that all hospitals ask patients about their Advance Healthcare Directives. If you have not done so previously, have a discussion with your physician prior to your admission.

However, that time is usually stressful enough, and if possible, the discussion should be done as an outpatient when a more relaxed discussion may be possible. Many doctors respond well if you let them know your intentions and questions at the start of the visit so that they can plan their time together with you. It may be helpful to write down your concerns and hand it to the physician at the beginning of your meeting.

How to Begin

There are many ways to frame a discussion. If someone close to you has died, you may be able to use that experience as a starting point to explain the aspects that you feel were positive, or those that were undesirable about that experience.

Communicate Your Values and Desires

Since it would be difficult to predict all the different possible scenarios that one might find oneself in at the end of life, it is better to convey to your physician your life values:

• What makes life meaningful and enjoyable for you?
• What is more important, living as long as possible or the quality of your life?
• What level of functional ability is necessary for you to feel that life has meaning? For example, do you need to be able to play golf?

Let your physician know about:

• Who is the person whom you want to make care decisions for you when you can't?
• If there are any special events or activities that you need to live long enough to experience, such as a grandchild's graduation?

You should also let your physician understand the things that help you cope with difficult times:

• Are you very religious or spiritual?
• How do you find strength in hard situations?

Express Your Concerns

During this discussion, you can express any fears or worries about your illness or medical care. If you are very frightened about shortness of breath or pain at the end of life, you can use this time to discuss the possible treatments. Your doctor may be able to explain some basic measures that may be options for you, such as CPR, mechanical ventilation and artificial tube feedings.

It is unreasonable, however to ask patients to understand all the risks and benefits of every possible medical intervention. For this reason, it is best to have a physician who understands your values and strengths. With your written Advance Healthcare Directive, and knowledge of you as a complete person, your physician along with your designated Agent can then tailor medical treatments to best suit your wishes and comfort at the end of life.