Like most doctors, Linda Girgis has seen firsthand why advance directives are so important.
She recalls working as a resident when a terminally ill patient coded. Without a written directive expressing the patient's wishes, doctors had no choice but to run a full code to revive the patient and place her on a ventilator, Girgis, a family physician in South River, New Jersey, told FierceHealthcare in an interview.
“There was really little chance she would ever be able to get off the ventilator," Girgis says. "She died a week later.”
Experiences like that may be why the majority of U.S. doctors (59%) have a living will. In contrast, about one-third of U.S. adults have an advance directive, according to a 2017 Health Affairs study.
Sermo, a social network for physicians, recently polled more than 2,000 doctors from around the world to see how many of them have advance care planning in place. Globally, 45% of physicians said they had a living will.
An advance directive, which often includes a living will, is made to ensure a patient’s wishes regarding medical treatment are carried out should the person be unable to communicate them to a doctor.
“We have all seen end-of-life cases and know what happens when advance directives are not in place. I think people outside of medicine don't think about it so much because they are outside of it and often don't face it until there is an urgency to it,” Girgis says.
Doctors are witness to what happens to terminally ill patients who don't have a living will and have no one to make decisions for them, she adds.
Some patients end up on ventilators with no hope for any meaningful life, an action that just protracts the inevitable. Like others, Girgis says she doesn’t want to end up in that position.
“I also don't want to have to put my family in that position where they have to make hard decisions,” she says.
In the Health Affairs study, the authors said the healthcare industry needs to address common barriers that keep patients from completing the documents. But for many doctors talking to patients about death and dying isn’t so easy.
“The best time to have the discussion is before it is an emergency,” Girgis says. In her practice, doctors ask patients about advance directives on intake forms and at every annual physical.
“Patients then see it as a routine question,” she says. If doctors wait to talk to patients when they are critically ill, they will often think they are dying and it becomes a very difficult subject. “It is always easier to have that discussion as part of a routine office visit than when the patient is crashing in the ICU,” she says.