When it comes to advance care planning, could physicians lead by example?

In April 2013, I spent a month conversing with colleagues about their advance care planning. I mostly spoke to docs in and around the Royal Columbian Hospital in New Westminster, British Columbia, where I work as a hospitalist. My conversation blitz peaked on April 16th, Canada’s third National Advance Care Planning Day. By that time, I’d spoken to 107 physicians and 37 other health care professionals.

Here’s what I asked my colleagues:

  1. If something happened and you could not make medical decisions for yourself, who do you know and trust to make those decisions on your behalf?
  2. How likely is it on a scale of 1-10 that this person would make decisions that honoured your wishes, values and preferences if you were facing a potentially terminal condition or profound disability?

I was a bit nervous my questions could make my colleagues uncomfortable, but regardless of how young or old, what specialty they practiced, how busy they were when I caught them, or if we hardly knew each other, they all felt this was important enough to talk about right here and now.

So, what were the results? Most doctors have a good sense of their preferences for care if they were not going to recover, and rated a 9 out of10 confidence that their loved ones knew their wishes. Surprisingly though, half had never actually had a dedicated conversation about the topic, the same percentage we find in the general public. This makes you wonder how justified their confidence is.

More importantly, I learned starting the conversation (107 times!) was not as difficult as I thought! I believe if we as physicians journey through our own ACP, it will help us in promoting and assisting our patients in pursuing theirs. Should I be wrong, at the very least we are leading by example and affording our families and ourselves the peace and comfort of knowing our wishes.

Dr. Joelle Bradley is a young physician and hospitalist at the Royal Columbian Hospital. She serves on the board of the Fraser Northwest Division of Family Practice where she is the lead physician for Advance Care Planning Steering Committee charged with improving advance care planning in the local community.

Need help getting the conversation started? We’ve got conversation starters and the Just Ask conversation card for talking with patients and families.