Read the full August eNews & President’s Message.
Advanced Care Planning – A Personal Perspective
Having an advanced care plan easily available to any health care professional—be it home care nurses, paramedics with EMS or nurses on an active care unit in hospital—is very useful. In our own clinic, we discuss a personal directive with every patient who has a review of their complex care plan. It would be good to include follow-up and incorporate a Green Sleeve to ensure completion of a personal directive. On reflection, why only during review of a complex care plan; why not incorporate this into an annual review with any patient?
I’ve recently had a very personal brush with legal documents such as Power of Attorney and Personal Directive. I was recognizing signs of illness in my own father and had embarked on obtaining these documents in a proactive manner. However, it may not have been truly proactive when one sees a family member deteriorating as proactive means doing this before something happens. My father then became seriously ill and was hospitalized quite suddenly before I had these documents ready. In the weeks following, I had to have documents transferred from my lawyer in Red Deer to a lawyer in Calgary, then have that lawyer meet with my father in hospital to get a Power of Attorney and Personal Directive in place. My father had the capacity to remain his own agent while this was being pursued, however, it could just as easily not have been the case. And, in all honesty, it was truly the Power of Attorney that was most important to my father. He was bedridden in hospital and could not look after his affairs (even though he knows the value of his bank accounts better than I know mine). Since having the Power of Attorney, I have looked after a tax installment, insurance payments and other bills, and my father is very relieved.
Is having the Green Sleeve on the refrigerator door the best place? I’m not sure. It needs be with the patient in question. I know of one case in which the family had done all the right things for a member of the family receiving palliative care. The Green Sleeve was on the door of the fridge, but this patient rapidly deteriorated, paramedics were called, but the Green Sleeve had disappeared (no one knows to where) and, as a result, there was no personal directive. A husband had to watch his terminally ill wife receive CPR when this was explicitly not her wish, yet there was nothing he could do.
The bottom line is to advocate with your patients to be proactive and explicit about advanced care planning and to have those plans readily available for when and where they are needed. It truly does provide a much higher quality of care for your patient.
Dr. Fred Janke, BSc, MSc, MD, FCFP, FRRMS
President, Alberta College of Family Physicians