Arizona doc develops guidelines to improve patient-physician conversations

Dr. Kevin Haselhorst is not your average ED physician. The Arizona-based Haselhorst has dedicated his career to engaging patients in end of life conversations. His approach is unconventional and flips the convention that doctors must initiate these conversations with their patients. In Haselhorst’s view, patients need to be proactive and feel empowered to ask their doctor if the care prescribed is what he or she wants or needs.

“Patients need to ask these questions. They need to ask themselves, what was happening when I got sick? What am I truly feeling?” explains Haselhorst.

Kevin Haselhorst (PRNewsFoto/Kevin Haselhorst)

Kevin Haselhorst (PRNewsFoto/Kevin Haselhorst)

He adds that patients of all ages have a tendency to develop a childlike demeanor when talking with their physician, and may leave important care decision up to provider, without questioning the plan that they may want at end of life. The following questions provide structure and are intended to empower adult conversations between patient and physician.

These 10 questions are as follows:

  1. Is this medical test necessary?
  2. Can you feel my pain?
  3. How am I supposed to cope with stress?
  4. How can I be sure you are taking me seriously?
  5. How are my listening skills?
  6. At what age do you classify me, physically and mentally?
  7. Would you ever recommend that I not see you again?
  8. Do you know how I will die?
  9. Where is the endpoint to my disease process or treatment?
  10. Do you know me as a spiritual being?

These are not questions that are typically asked of doctors in EDs across the county. But Haselhorst sees emergency medicine as a gateway to end of life care.

Haselhorst argues that his unique position in the ED makes patients more likely to engage with him about end of life than they would with their primary care physician, with whom they may have a long-standing relationship.

“I have fresh eyes and am with that patient in the short-term. That gives me a license to take a chance.” added Haselhorst. “I can see intuitively when patients are sick.”

If a larger number of patients were to bring these questions to their physician, it would likely change the care experience dramatically, according to the doctor.  But patients are not. And when they are, physicians are ill-equipped to respond.

Haselhorst shares that these types of conversations sometimes shock his colleagues.  “Their jaws drop” he said. Providers are not having these types of conversations with their patients, and are especially surprised to hear these conversations occur between a patient and an ED physician, where palliative care is not usually discussed.

Patients asking these questions of their physician are more likely to have a smoother transition into palliative care.

According to Haselhorst, “Palliative care is about choice.” And in his work, he is helping patients find their voice and make thoughtful, informed decisions about their care.

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