September 20, 2014

Warning! Terminology Is Important

When a doctor or nurse asks you who is your emergency contact, do you know whom they are asking about – 1) the actual person to contact for an emergency, 2) the person who is authorized to speak for you near the end-of-life, or 3) the person authorized to make decisions for you and has a durable medical power of attorney.

WARNING! Most medical providers and hospitals use the first one mistakenly. There is a difference in how these people may do things for you. The first person generally is the person that will contact the rest of the family and can make some minor decisions. Often this person is a spouse and often can fill all three roles.

Sometimes the spouse does not want the responsibility or is incapable of acting and the person in role 2 above is correct. This person can be a trusted friend, family member (an adult son or daughter), or other relative. The third role is the most difficult and most doctors and hospitals do not want to see this one and will often do their best to side step this person. Sometimes this person can also be an advocate for the patient and the medical profession will totally ignore this person serving in dual roles.

The point I am trying to make, don't count on your wishes being followed. I have seen this violated more often than I care to remember. It is violated by everyone from nurses to doctors, to hospital employees, to hospital administrators, and family members and this makes me sick.

Then to read about this study at the Henry Ford Hospital in Detroit added to my concerns. More than 95 percent of patients treated in an Emergency Department mistake their emergency contact as the designated medical decision maker for end-of-life care, according to a new study by Henry Ford Hospital in Detroit. The study is being presented Wednesday at the 20th International Congress on Palliative Care in Montreal.

The researchers sought to determine whether there was a correlation between the role of an emergency contact and advance directive. At various entry points into the health care system, patients are repeatedly asked to provide emergency contact information even though the health care industry doesn’t universally define what that is.

For its study, researchers surveyed 308 patients who were treated in Henry Ford’s Emergency Department in Detroit between December 2012 and April 2013. Of that number, 34 patients had an advance directive but only half of them provided a copy of it to their primary care physician.

Highlights of the survey:
99 percent said their emergency contact should be able to come to the hospital if needed.
• 97 percent of patients said they wanted their emergency contact to notify important family members if they were sick and could not do so.
• 97 percent of patients said their emergency contact should know what type of care they would want if they could not voice it.
• 95 percent expected their emergency contact should be able to tell the medical team what their wishes were if they could not.
When asked why they chose their emergency contact:
• 80 percent of patients said the emergency contact was the best way to get in touch with them.
• 43 percent said they were the designated medical decision maker.”

Erin Zimny, M.D., a Henry Ford Emergency Medicine and Palliative Care physician and a study co-author, says health literacy, which is one reason cited for low advance directive completion rates, did not play a role in their study.

We’re using an antiquated vocabulary in medicine,” she says. “We should be asking and educating patients about the importance of an advance directive instead of defaulting to the emergency contact world.” “

The study was funded by Henry Ford Hospital.

This type of information puts everyone on notice that more care needs to be taken to make sure that your wishes are followed. More on this in a future blog.

No comments: