“Where’s That Advance Directive?” In the New York Times recently, Paula Span interviewed a hospital social worker about the unavailability of people’s advance directives at the hospital. She faces this problem at least once a week: patients—who have already signed advance directives—arrive at the hospital without them.
This social worker paints a picture of the fallout from not having the documents in a timely manner: delay of medical treatment, a near-miss in having the wrong person make health care decisions for the patient, and more. Frustrated, she concludes with the obvious: we waste our hard work making these decisions and having the difficult conversations with our loved ones if the documents aren’t there when it counts.
Taking up where Ms. Span left off, here are six of the most common myths people rely on when they assume that their advance directives will be available at the hospital—and why they are mistaken.
- “My family has a copy and will remember to bring it to the hospital.” Well, it’s unlikely. In an emergency, the last thing on your loved one’s mind is your paperwork. In a time of crisis, your most capable loved ones will remain calm and focus their energy on you. Others may simply panic. An estate planning attorney admitted to me that, in the midst of his father’s heart attack, he didn’t think to get his dad’s advance directive before they left the house. “If I can’t remember to do this,” he observed, “how could I possibly expect my clients to remember?”
- “If I forget it, my family can just go home for it.” Maybe—but at potentially great cost. Your loved one may have to leave you alone in the hospital when you are at your most vulnerable. And going home to get it can hold up your treatment. On the flip side, in cases of serious trauma, there may not be enough time to get it. Emergency medicine physicians talk about the “golden hour,” essentially the first 60 minutes during which vital decisions may need to be made about your care. You could run the risk of your wishes not being honored if they are not known right away.
- “My family knows where I keep it and will be able to find it.” Aside from the very neatest among us, does this one need a lot of debunking?
- “My hospital has it already.” Irrelevant. This may be surprising, but don’t expect your hospital to look for your advance directive just because you gave it to them previously. (It would take too much time for them to go dig it out of your old chart from a prior hospital admission or episode.) Even with an electronic medical record, an advance directive can be hard to find, because some of these systems don’t have a designated place for it. And some hospitals may have multiple electronic medical record systems that don’t talk to each other.
- “My advance directive is on a USB key (thumb drive) that I keep with me.” Useless. A hospital worth its salt in patient confidentiality and virus protection is not going to plug your thumb drive into its computer system.
- “My doctor and my lawyer have copies if I need a backup.” Don’t rely on either of these as your primary emergency backup. They can help you Monday–Friday during business hours, but are their offices open at 2 am? On Sunday? Doctors’ and lawyers’ offices are only open about 20% of the time in a whole week.
What suggestions do you give your clients on how to make their directives accessible? Please email me your best advice; I will share the results in next month’s blog post.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directives registry in the U.S., which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A board member for the Center for Advocacy for the Rights and Interests of the Elderly and a member of the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, she is active in health education and public engagement related to advance care planning and advance directives and serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative. Randi is an ongoing contributor to the Academy blog.
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Randi:
Great blog!! I am posting a blog of my own that reprints your comments. It should be up by tomorrow. I played your video for my CAS last night, and will do it again Tuesday night. I’m going to play it on my iPad as I do intakes. Thanks for such an articulate expose of the objections and reasons that people raise not to take a membership.