PROVIDER PERSPECTIVE:
Suzanne Fields (2)
Text Transcript

The other area that I find particularly difficult as a Geriatrician is how to approach advanced directives because these are, I think, culturally based to some extent and how I interact as a physician…again, the problems are universal.

You have a 97-year-old parent who has advanced dementia, can't feed himself, bathe himself, dress himself, how aggressive should you be with that patient in treating the pneumonia? Should you put a feeding tube in a patient who is not eating enough? And how do you talk to families about their loved ones?

We have in medical schools today an approach, that uses like a European model, that... we have to recognize and respect what the patient wants and what the family wants. But what I have found in my practice is that depending on the culture of the family, it is often very difficult, especially in Asiatic cultures, to talk about advanced directives to the family. I have fellows who are from Pakistan and doctors don't do this in Pakistan. Families look to the doctors to advise them what to do. And so I've tried to walk a delicate line with these families, taking on some of the burden of decision making and yet still try to offer them choices in cases that are extremely difficult.