Advance Directives Improve Satisfaction for Patients, Families and Physicians

October 29, 2015
Heather Lavoie, Chief Strategy Officer, Geneia


I know firsthand that you can never predict precisely when you or a loved one will need an advance directive. Just this year, advance directives - or in my family what we still call living wills - came up twice, one situation much more predictable than the other.

This winter, my 94-year-old grandmother Anita passed. She died at home, in a hospital bed in her living room, with my father and his wife at her side.  Because she had been sick for months, we had the gift of time - time to have the kind of conversations people regret not having, time to say a long and meaningful goodbye, time to have a conversation about her last wishes and document them in a living will.  We all knew she wanted to convalesce at home and to die there, and we worked together to honor her desires.

In sharp contrast, my 42-year-old husband was very unexpectedly admitted to the hospital this summer.  He had been in excruciating pain for days, and just as I was leaving on a business trip, his doctor advised him to go to the Emergency Department.  It turns out he had a pulmonary embolism - otherwise known as blood clots in his lungs.  He ultimately made a full recovery but his experience was full of scary moments.  In the midst of his healthcare crisis, it was heartening to me that the emergency medicine physician took the time to ask about his advance directives.

It turns out that my husband and I are a bit of an anomaly.  Perhaps because between us we have a blended family of four kids still at home, we had taken the time to create living wills and to make our wishes known to each other and to the attorney who helped us write them.  They are stored in a bank safety deposit box with our other important documents.

Almost immediately, we realized the challenge of storage and retrieval of our living wills.  At a time when decisions often need to be made immediately, finding a person who could travel to our safety deposit box during banking hours with the correct key to retrieve our paper documents was wholly insufficient and unrealistic. 

Undoubtedly that's why Geneia’s recent survey of emergency medicine physicians revealed their sentiment about the challenges of timely access to advance directives:

  • 92% of emergency medicine doctors agree that the system by which we inquire, access, update or retain a patient’s advance directive needs to be improved.
  • 95% say they encounter problems locating or accessing patients’ advance directives.
When asked open-ended questions, the majority of emergency medicine physicians (54%) volunteered the word “relief” upon learning an advanced directive is easily accessible while others used terms such as happy, grateful, empowered, and thrilled. These emotional words offered by clinical thinkers illustrate the power behind advance directive documents. 

One hundred percent agree that that it is important to have an advance directive prepared in case of emergency (90% very important), and nearly all agree (93%) that they are less frustrated in cases where an advance directive is easily accessible.  

In the words of Carrie Mendoza, MD, FACEP, emergency medicine physician and judge for the Geneia Joy of Medicine Challenge, “Advance directives help improve satisfaction for patients, families, and physicians.” And they are an important way to restore the Joy of Medicine for emergency medicine doctors. 

Perhaps coincidentally – although not at all by my doing – the Geneia Joy of Medicine Challenge winner was selected by the physician judges the same night my husband was in the emergency department waiting to be admitted to the hospital.  Hashim Zaidi, MD, an emergency medicine resident at Northwestern Memorial Hospital/McGraw Medical Center, was chosen for his idea to embed advance directives on drivers' licenses.  Emergency medicine doctors like Dr. Zaidi understand how important it is not only have an advance directive but for it to be available to the treating physician precisely when it is needed.  

As the grand prize winner, Dr. Zaidi has received Geneia consulting resources to further develop his idea.  Since then, we've been working to create a pilot program with a diverse group of healthcare stakeholders to put advance directives in the hands of physicians at the point of care.  I look forward to telling you more about our project later this year, and in the meantime, I urge you to complete your advance directive today.  Visit the National Hospice and Palliative Care Organization resource page to download state-specific information.

Without a doubt, advance directives are good for our health.


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