The 411 on Planning Your Medical Care

Dr. Joan Harrold I Lancaster Newspapers, April 16, 2019

Can you imagine being too sick to talk to your doctor? You need a plan. Can you imagine being in the hospital and having difficulty making decisions about your treatment choices? You, too, need a plan.

You can’t imagine anything at all like that? You definitely need a plan.

Even if you have a document-advance directive, living will or health care power of attorney, you need a plan. Documents are good. Planning and telling people what is important to you is better.

Why have a plan? A plan increases the likelihood that you get the care you want, have the kind of life you want and avoid things you don’t want. It also relieves some of the burden on your family. It is difficult when you are sick; it is even more difficult when they do not know what you want.

Who knows you well enough to make decisions for you if you cannot? Who do you trust to push the envelope, hold the line, ask the hard questions and make the tough calls? Your decision-maker may seem obvious — your spouse, your oldest child, your closest relative. However, consider two key points. First, this person needs to make decisions as close as possible to what you would make. Second, this person needs to make these decisions when emotions are high. This is not a popularity contest; it’s not about whom you love the most. Choose someone who can stand in your shoes and confidently make the decisions you would make for yourself.

What should your plan include? Even if you are young and healthy, it is important that you name a decision-maker. If you have particular concerns, medical issues, or need complicated care, add details. While your plan should include end-of-life preferences, it should include your preferences for care at other times as well. What is most important to you? How would you want to live? What do you want to avoid? Where are you willing to live? What trade-offs are you willing to make? What “bad” outcomes are you willing to accept to live longer? What personal, religious, ethical or family considerations are important to you?

When should you make a plan? At 18 years old, choose a decision-maker. Then update your plan whenever your circumstances and preferences change. Consider changes:

  • Every 10 years if you are healthy.
  • Whenever you have a new or serious medical diagnosis.
  • If you have a medical condition that will worsen over time
  • If you have been in the hospital or had treatments that change your thoughts about the kind of care you want.

How do you talk about your plan? Ideally, you make these plans the same way you make other important decisions — with the people who are most important to you. If some don’t agree with your plan, it is even more important that they know what you have decided and who your decision-maker is. Don’t let them be surprised at a difficult time. It is better to talk with people who matter to you — because you matter to them.|

Give people notice that you want to talk. This is not a “by the way” conversation, a posting on social media or something you write in a holiday letter. Start with something simple: “Nothing urgent, but when you have a few minutes, I need to talk with you about some things I am working on to plan for the future.” Let people know it is important and will take a little time.

Thanksgiving may be one good time to talk. People are together. You can explain your plan and how it can be helpful. Everyone can ask questions. Once people expect these conversations, they will be less surprised if there is an update “same time, next year.” And, of course, there are easy ways to end the conversation: “time for dessert” or “let’s take a walk after all that turkey” or “when do we eat?”

Where should you keep a copy of your plan? Advance care planning usually includes completing one or more of the documents mentioned above. Give a copy to your decision-maker, other important members of your family and your doctors. Have it entered into your hospital record. Do not hide it, or it may not help when you really need it.

The 411? If you’re 18 years old, healthy or not so much, name a decision-maker and make your plan.

Dr. Joan Harrold is the medical director of Hospice & Community Care, which has locations in Mount Joy and Lancaster, and Palliative Medicine Consultants.