Identifying Medical Proxy Should Be Part Of Routine Medical Care

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Identifying Medical Proxy Should Be Part Of Routine Medical Care

http://www.medicalnewstoday.com/medicalnews.php?newsid=48171

One-third of married individuals choose someone other than their

spouse as a surrogate for medical decision-making. And more often

than not, when adult patients chose a parent, sibling or child, they

prefer their mothers, sisters and daughters to serve as medical

proxies over their fathers, brothers and sons.

These are among the results of a study on advance care planning

conducted by Northwestern University researcher K. Lipkin,

M.D., available in the online early edition of the Journal of General

Internal Medicine (http://www.blackwell-synergy.com/toc/jgi/0/0).

Lipkin is assistant professor of clinical preventive medicine at

Northwestern University Feinberg School of Medicine.

The finding that 33 percent of the married patients in the study did

not choose their spouse as surrogate is noteworthy, because

physicians regularly look to spouses as informal surrogates.

Additionally, over a quarter of survey participants chose someone

other than the person identified as an emergency contact to act as

proxy in medical decision-making.

" When patients choose a surrogate who is not the person doctors would

usually consult or who would not become empowered as a substitute

decision-maker under state laws, physicians are alerted to engage

these patients in an advance care planning process that ensures the

formal appointment of their desired health care agent, " Lipkin said.

" Emphasis on end-of-life care, terminal illness and the use or

discontinuation of life-sustaining medical treatment [as in the Terri

Schiavo case] has obscured the need for advance planning in the

regular care of all competent adult patients, " Lipkin said.

Lipkin commented that doctors do not ordinarily consider advance

planning unless patients are elderly or seriously ill. At the same

time, he and others have found, most patients are willing to discuss

plans for future medical care and are waiting for their

physicians " to begin the conversation and to raise the necessary

questions. "

Lipkin designed and conducted a survey of over 300 participants to

determine whether they were willing and able to designate a specific

person to act as a surrogate for medical decision-making at the time

of a routine health care appointment.

Study participants were of different ages (19 to 96 years) in various

states of health, who were electively seeking medical evaluation or

treatment and who were considered competent to make their own medical

decisions.

Of the patients interviewed, over 90 percent supported the idea of

asking patients to designate a proxy for health care on a routine

basis. Yet, less than 26 percent of patients had previously been

asked to identify a surrogate in the course of ordinary medical care.

When asked if they would want to name a proxy for health care " now, "

that is, if their doctor asked them to at this particular time, more

than 85 percent answered " yes. "

Lipkin said that identifying a proxy for health care as part of

routine medical inquiry offers several immediate clinical advantages.

First, the door is opened for ongoing advance care planning

discussions between patients and their doctors. Second, the benefits

of choosing a health care agent are made available to all competent

patients -- not only to the terminally ill, the very sick or the very

old. Third, documentation of a competent patient's proxy preference

in his/her medical record constitutes " clear and convincing evidence "

of prior patient wishes in case of incapacitation -- providing a

safety net until more definitive planning is accomplished.

Lipkin regards the routine identification of a proxy for health care

as a door-opening first step for ongoing conversations between

doctors, patients and families - conversations that emphasize the

important relationships and values of patients and their loved ones.

The nature of this process encourages continuing interchange,

strengthens the patient's relationship with his/her physician and

promotes continuity of care.

" Advance care planning is not about documents -- it is about persons

and their relationships, " Lipkin said.

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Participants for this study were patients at the General Eye Clinic

of the University of Chicago, where Lipkin had been a faculty member

of the Pritzker School of Medicine.