'Doctor, Don't Give Up on Me!'

Leigh Page

Disclosures

March 16, 2016

In This Article

Patients Have Their Own View on Life or Death

There's a belief gaining popularity that when patients seem to be nearing death's door, doctors should back off from aggressive medical care and let them die in peace.

Providing "heroic" care has become a negative, and many doctors are stepping back from it. According to a 2011 study,[1] 42% of primary care physicians believed they were overtreating patients.

And yet some patients—even when debilitated by metastatic cancer, brain injury, or old age—still want to keep on fighting. They don't want the doctor to give up on them, and there are many documented cases when that extra boost has saved their lives.

These patients may be a minority, but they are a significant minority, and their numbers appear to be growing. A study[2] released in fall 2015 found that nearly one third of people who fill out advance healthcare directives requested medical interventions. And while polls[3] conducted by the Pew Research Center show that 15% of the American public in 1990 agreed that that everything possible should be done to save a patient's life, that figure rose to 31% by 2013.

This comes at a time when there is more pressure for physicians to tone down the "heroic" or "end-of-life" medical interventions. And there have been discussions in which physicians say that they believe that lesser efforts are what patients prefer. But is that really true?

Clearly, patients have widely different expectations for so-called "end-of-life" care, so it can be challenging to determine what treatment they should get. Moreover, many don't even think about their preferences until they get very ill. According to one recent survey,[4] only one third of Americans have a living will spelling out whether they want life-sustaining medical care in case they are incapacitated.

Helping patients figure out their own advance directives can be a time-consuming endeavor for physicians; and up until now, it couldn't be reimbursed. Starting in January 2016, Medicare is paying physicians roughly $86 for the first half hour of discussions and $75 for the next half hour, according to a Medscape report.[5]

Reimbursement for advance care planning, however, won't address the issue of treating patients who don't want their care to be stopped.

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