But perhaps the more overwhelming barrier is psychological. After all, such heart-to-heart conversations promise to be difficult, both for physician and patient, and often create discomfort. We care about our patients. But too often patients live in a degree of denial. Few want to confront the issue of long-term care—so often a precursor of mortality.
All of us also are unduly optimistic about how long we're going to stay healthy. We hesitate to accept the incontrovertible fact that all of us ride a trajectory that ultimately reaches an endpoint.
Similarly, bringing up long-term care with patients can seem the equivalent of delivering a poor prognosis. We worry that offering such guidance will leave our patients depressed, even hopeless. We perceive long-term care, mistakenly, as an admission that we've failed our patient. Instead, we often wait for patients to raise the issue.
So if we can avoid this conversation, chances are we will. And in doing what we believe to be right, we're actually committing a wrong.
Bypassing this conversation can have serious consequences. Patients who need to be alerted to and educated about long-term care may be ill-informed and even ignorant about the choices available and what those choices might mean. Chronic health issues that could be prevented from progressing may worsen. Such inaction could increase emergency room visits and hospital admissions and drive healthcare costs higher. The medical community as a whole has to change this equation, and soon.
Current healthcare reform initiatives touch only minimally on this undercurrent. Yet, with an estimated 70% of Americans over age 65 now expected to require some kind of long-term care, this conversation will be increasingly pivotal.
I've seen the price we pay for avoiding this physician-patient dialogue, first for 29 years as a practicing family physician and now as CMO with a company that supports long-term care. I've studied the issue, given lectures about it and promoted continuing education efforts for physicians.