No Incentives for Docs to Talk about End of Life

John Carney

January 12, 2010

The reasons doctors don't discuss advanced progressive disease and declining health status with patients more often is that there is no incentive to do so.

Providers get paid to treat, and patients who are willing to undergo progressively burdensome interventions, hoping against hope, get their treatments covered. Docs rarely talk about acute or chronic disease process in stages (early, mid and advanced) even with patients of advanced age.

Patients don't ask. Doctors don't tell.

For years, those of us who've dedicated our lives to improving life in its final chapters resort to blue humor and sad references that Americans are the only people on earth who consider death an optional event. It isn't a laughing matter.

Redirecting goals of treatment to realistic achievable outcomes isn't rocket science Neither is is talking about progressive disease, realistically and compassionately. It may take longer than not talking, but until we value the professional relationship enough to pay for the conversation, it will remain elusive.

We must reframe the conspiracy of silence from its current notion of acceptability to the deceptive practice it is, depriving all of us of the patient autonomy we claim as sacred.

If healthcare reform does nothing more than help realign payment incentives to the point that doctors and patients can abandon magical thinking and address advanced disease more honestly, then maybe something good for both patient and provider can come from the last nine months.

For the eventual and humorless outcomes we all face, it's time.

Links:

Facing End-of-Life Talks, Doctors Choose to Wait, New York Times, January 11, 2010

Paradoxes in Advance Care Planning: The Complex Relationship of Oncology Patients, Their Physicians, and Advance Medical Directives, Journal of Clinical Oncology, January 2010