Proactive Care or Reactive Care?

Stephanie Specht's picture
By Stephanie Specht on April 10, 2017

It is not something anyone likes to think about, but preparing for the future can make all the difference if you have a health crisis or become incapacitated. Would you want all of the heroics that modern medicine can provide or is comfort and quality of life more important?

In an emergency situation, if your wishes are not known then you might not have a choice. That is why it is important to create an advance care directive, such as a living will. These written, legal documents spell out medical treatments you would and would not want to be used to keep you alive, as well as other decisions such as pain management or organ donation.

Ralph Caldroney, M.D., a Carilion Clinic internal medicine physician, encourages all of his patients to be proactive and not reactive when it comes to decisions about future health care.

“In the absence of a living will or other advance care directive, medical care providers are going to provide any and all levels of care that they deem appropriate,” he said. “And family members want loved ones to live forever, so if they are not aware of your wishes their decisions are often from the heart and not the head.”

Taking that responsibility out of your family’s hands and putting it down on paper is the best way to ensure that you get the kind of care you want. Once certain medical steps have been taken in a crisis situation, it can be hard to undo it and needless pain and emotional distress for all concerned often follows.

When determining your wishes, think about what is most important to you:

  • Is it independence, comfort or longevity?
  • What kind of treatment would you want to undergo to extend your life?
  • Would you want treatment only if a cure is possible?

“Only you can define when quantity has overstepped quality, so make it easy for your family and make your wishes for care very specific,” Dr. Caldroney explained.

When making these decisions, Dr. Caldroney also suggested involving your primary care provider or whoever you feel is your managing provider/physician. Your doctor can help you devise a plan for care and answer your questions about different kinds of treatment, such as resuscitation, mechanical ventilation, tube feeding, dialysis, palliative care (comfort care), hospice care, and organ and tissue donations.

When working with your doctor, Dr. Caldroney said to keep the following in mind:

  • Set up a separate appointment with your physician to discuss your medical wishes. Don’t try to have this discussion at the tail end of a regular visit.
  • You will need an adequate amount of time to discuss the details, so schedule at least 30 minutes to an hour with your doctor.
  • Schedule the appointment at the end of the day, so your provider won’t be rushed to get to the next patient.
  • Bring as many written documents as possible that relate to your wishes for care to the appointment. There are several templates or preprinted forms that you can use as a guide, such as those available through the Virginia Department of Health.  
  • Be as specific as possible about what you want to be done and not done.
  • Bring your spouse/primary caregiver or the person that is your designated power of attorney with you to the appointment. But don’t worry about including other family members. If too many people are involved, it can be hard to delve into the details of the discussion.

Once you have completed your advance care directive, give a hard or digital copy to the appropriate family members or caregivers. Make sure they understand and are aware of your wishes and the medical treatment you want. It is also a good idea to give a copy to your physician.

In today’s digital age, you can easily store your advance directive electronically so it is available for any and all health care settings within this country. Save it on your phone or tablet and set up a registry on the Virginia Department of Health’s registry page.

Take steps now to ensure that you receive the care you want in the future. When you and your loved ones are in crisis mode, it is hard for everyone to make rational decisions. If you have questions about what to include in your advance care directive, ask your family physician. To find a provider near you, visit CarilionClinic.org/providers.