Are Your Health Wishes Known?

By Dr. John Ropp | Family Physician | Hartsville

When my wife and I married seventeen years ago, our eight grandparents attended the wedding on a warm May evening.  A picture of them together stands as one of our most treasured memories from that special day.  What is even more special, however, is that five of them remain with us today and our children have grown up knowing them well.   The years have not passed, though, without some very difficult discussions and decisions about their well-being, medical care, and other plans if and when they need additional attention.  In the last several weeks alone, I have advised my parents and in-laws concerning matters with their parents, and I sat with neighbors around their dining room table to consider alternatives for their aged mother.  Many of you know what hard talks these can be with family members and other special people in our lives.  Often, we delay speaking until a problem arises that forces us to face a reality- that there will probably come a time when our loved one’s health will not improve or when they cannot take care of themselves any longer.  What then? 

This month we celebrate National Health Decisions Day and as a family physician, I encourage you to take several actions to insure that you and your family have communicated your wishes with one another throughout various life stages.  As a doctor who cares for many seriously ill patients, I cannot tell you how important these discussions are for the peace of everyone involved in a person’s life.  First, please identify a health care power of attorney for yourself and ask other adult members in the family to do the same.  A local attorney can help you with this and other advance directives that may be helpful as well.  Second, when you are diagnosed with a medical condition that you will live with for the rest of your life, please establish and maintain good communication with your primary care physician through the years.  This step will insure appropriate care is provided no matter how long you live with the condition as you continue efforts to cure the malady.  Finally, when a disease process becomes overwhelming or when care needs are extraordinary in a person who is nearing the end of life, consider the appropriateness of more direct palliative care in discussions with your doctor.  Goals to relieve pain and suffering, while honoring patient wishes and dignity, are a hallmark of this care. 

Additionally, we are very pleased that the start of the South Carolina Physicians Order for Scope of Treatment (SC POST) pilot study coincides with NHDD this year.  Our state coalition has worked long and hard to insure that all seriously ill patients in South Carolina and their families have an active voice in their health decisions and communicate these wishes with their physicians and other providers.  I hope you will help join us in this effort by taking the action steps suggested so that we can deliver the best care to our most vulnerable patients.

A Message from The President: Health Care Decisions

Bruce A. Snyder, MD | SCMA President

Today marks the Seventh Annual National Healthcare Decisions Day. As physicians, we often spend a great deal of time talking with our patients about end-of-life-care issues, but today I want to remind you that it is equally important that we take the time to also make those decisions for ourselves.

The goal of National Healthcare Decisions Day is to ensure that all adults with decision-making capacity in America have both the information and the opportunity to communicate and document their future healthcare decisions.  The first years’ results were impressive—over 750,000 people obtained resources to make their health care decisions known.

My siblings and I have experienced the advantage of our parents open discussions and planning for their futures.  We were pleased that both of our parents completed Advance Directives with the advice of their physicians.  Twenty years ago my mother chose to not again be placed on a ventilator because of her day to day struggles due to severe emphysema.  Likewise two years ago my father died without aggressive intervention or CPR.   Both understood their need to make the decision that was most appropriate for them, and to share that with their loved ones.  My mother was confined to the home, required a walker, slept poorly, and was constantly short of breath even with oxygen.  Two years earlier she spent five days on a ventilator and was able to return home, but saw her health steadily deteriorate and therefore eventually chose comfort care.  My father at age 85 started dialysis and for over two years was able to drive himself back and forth for treatments three days a week, have an active social life, and remain active in his church.  Then as his health deteriorated, he required transportation for his dialysis treatments, required an electric scooter, and became short of breath with minimal activity.  He discussed his options with his physicians, family, and friends; and then he also decided not to undergo more extensive care. I had served as his health care agent with his wish for me to make healthcare decisions if he could not make them for himself.  Having completed both his Advance Directive and Health Care Power of Attorney gave him and all of his children assurance that his wishes would be followed and when confronted with his final illness, I was able to honor his wishes.

I encourage you to visit www.nationalhealthcaredecisionday.org for a variety of free information (including free advance directives forms for every state) and tools to assist you with your own thoughtful reflection on your healthcare choices.

I also encourage you to check out the work being done by our very own SC Coalition for the Care of the Seriously Ill (CSI). Their mission is that all persons in South Carolina with serious, chronic or terminal illnesses will have an active voice in the care decision process.

I hope you will take the time to spread the word to your patients, as well as make your own wishes known to your loved ones---- remember, your health care decisions matter, too.

Good night, Honey?

By Dr. John Ropp, Hartsville Family Physician, SCMA Young Physicians Trustee

If I had a quarter for every time a parent asked me what OTC medicine they can use for their kid’s cough and cold, well…I could probably make up the 2% loss in practice revenue from this year’s sequestration.  Since this is not a billable code under ICD-10, however, then perhaps I will have to wait for ICD-11 or 12.  In the meantime, I was encouraged to read an article in a recent issue of The Journal of FamilyPractice that offered a simple, time-tested remedy for the parent (yes, the parent) of kids who fall ill due to the latest cough illness making the ____________ (fill in blank here for child location of choice- school, church, playgroup, ballclub, other) rounds.  For as we all know, the late night childhood cough is a phenomenon unlike any others and must certainly be an invention of the demons designed to minimally affect the ill, but to inflict the greatest harm on their guardian- the loss of sleep and the gain of anxieties.  But rest assured, oh sleepless parent, for grandma was spot on- the sweet elixir of honey can calm the cough.   The article title gives the answer- “A spoonful of honey helps a coughing child sleep,” and the article goes on to describe the randomized controlled trial that studied children between the ages of one to five years old with a nocturnal cough of less than seven days duration.  They excluded other obvious or possibly more serious conditions and randomized each child to receive 1.5 teaspoons of one of three honey types or placebo 30 minutes prior to bedtime.  Follow up results showed that there were statistically significant differences in efficacy for the honey groups (but not favoring one over the other) versus the placebo.  Of course, our dentist friends will remind us to use this remedy sparingly due to the sugar content, and we will need to continue preaching caution to children less than one year of age, but this would be a nice recommendation if we can break our collective OTC drug habits.  When faced with getting a good night’s rest themselves, though, it’s good to know that we might reach for the pantry instead of the drug shelf.  Sleep tight, honey.

Ashkin MD, Evan and Mounsey MD, Anne (March 2013). A spoonful of honey helps a coughing child sleep.  The Journal of Family Practice, Vol 62, No. 3.  Retrieved from jfponline.com.