Early Conversations Can Make Tough Decisions Easier

Communication is key

When it comes to providing the best care, communication between a patient and health care provider is absolutely essential. And when it comes to providing the care you would want to receive if you are unable to speak for yourself, it’s also essential to have your loved ones know your wishes.

“It's crucial that a patient, their family and the physician are on the same page as far as what a patient would want for their care,” said Dr. Shana Peper, an internal medicine provider at Methodist Physicians Clinic Indian Hills. “Whether it's your spouse, your children or somebody else who is able to speak for you, we want to honor your wishes when you're unable to do so yourself. We want to continue to respect you as a person, and that means doing what you would want instead of what the physician or others feel we should do.”

A new way to express your wishes

More often than we realize, life threatening problems occur suddenly, or leave the patient unconscious or otherwise unable to make their own decisions. Now, providers have a new tool called Nebraska Emergency Treatment Orders (NETO). It’s a document that can quickly communicate the most important medical decisions to all medical providers – whether it be EMS/911 or hospital personnel. 

The NETO is usually completed during a visit with your primary care provider. It then becomes a standardized declaration of your treatment choices that health care providers and your family can follow. 

Standardized care starts at the time of crisis

Many people fail to plan because they don’t know what to plan for. They are overwhelmed by the complexity of the decisions, so they are left without a plan at all. The truth is, just four multiple choice questions can answer most of the urgent issues in the time of a crisis. Because the questions are standardized, it helps convey complex medical information quickly and efficiently to providers across the entire spectrum of care.

“As physicians, we're often in scenarios where somebody is maybe suddenly ill or a terminal disease has progressed to the point where the patient is not able to make decisions for themselves. In those cases, the family may be understandably distraught with sorrow and grief, and it becomes hard for them to speak on behalf of the patient or remember if they've ever had any of those conversations. That’s why it’s of utmost importance that those conversations start when we're healthy and they involve your physician.”

Dr. Shana Peper

Methodist Physicians Clinic internal medicine

What questions to ask

Since we are preparing for a situation that hasn’t yet happened, it can be difficult to know what questions to ask. What is the right level of treatment for you? Not every patient wants everything medicine has to offer, so it’s good to know you can control the length and intensity of treatment:

• Do you want invasive treatments such as intubation to help you breathe?
• Would you want to stop treatment if it was going poorly, or if serious problems arose?
• Would you want to be on long-term life support? 
• Do you know what CPR is, or if it would be effective for you?
• Have you ever considered being kept alive with medically administered nutrition?  

“Having a NETO is about making difficult decisions easier,” said Rev. Melissa Strong, Service Leader for Pastoral Services at Methodist Hospital, “It has to do with making sure that a patient’s wishes are heard and talked about in an open manner, and that we have the appropriate care for the appropriate patient.”

Plan for today and revise as your life changes

“People should plan for the forseeable future,” said Dr. Lou Lukas, a palliative care physician at Methodist Hospital. “We want people to think about if something happened to you tomorrow, what you would be willing to go through to try to get more time. This answer changes as our families and health changes, so our plans should change over time to match our lives.” 

If your life and health change, the choices you make in your NETO can change, too. The NETO form can be updated with a simple trip to the doctor. 

“It’s a bright yellow piece of paper you can keep on hand for emergency crews that may respond,” said Dr. Lukas, “or there is also a small card you can carry in your wallet so if you’re in a crisis away from home, people can find it and follow your directive. The NETO form also comes up as part of your medical record, so if you come into our emergency room, we know what your wishes are.”

Getting everyone on the same page

Putting these few decision in written form can make all the difference to your family at the time of an emergency.

“Sometimes families disagree on things,” said Rev. Strong. “Having a document that spells out your wishes allows your decisions to stand no matter what the discussion or disagreement. For your peace of mind, and your family’s, think about what is important to you and share that with your family and your physician.”

Following your wishes and respecting your choices is every health care provider’s goal – even when you are unable to speak for yourself. Having the conversation early and often is the best way to help ensure your health care plan is understood.

For more information about completing NETO, speak with your Methodist Physicians Clinic health care provider.