I recently wrote about the idea of making advance directives a condition of obtaining Medicare benefits. Such a move, one major healthcare CEO told me, would be a great way to help reduce the cost of care for patients at the end of life, where so much expensive treatment with dubious results takes place.
It's a good idea… in theory. In current practice, there are some problems, says Ferdinando Mirarchi, DO, who is chairman of the department of emergency medicine at UPMC-Hamot in Erie, PA.
My recent conversation with Mirarchi added some much-needed nuance to the debate about how wise it is, both for patients and physicians, to have these documents in play without greater safeguards and training of clinicians to better interpret what the patient really wants from his or her care when incapacitated.
Mirarchi believes that the standardization and interpretation of advance directives pose grave threats to patient care and to physicians, and he speaks from experience.
"I almost killed a patient," he says, matter-of-factly.
The first physician on the scene when a patient presented at the ED unconscious, he "was at the point of not treating her because there was a living will and a DNR."
A cardiologist who noticed the dithering at the patient's bedside, screamed "What are you doing?!" at Mirarchi, and roughly shoved him out of the way.