Calling attention to health-care directives

Increasingly, medically savvy patients expect their physicians to help them take control of their own health. But, as an RPAP student in Staples (population 3,019) last year, Josh Chapman, Class of 2007, found that patients tend to be a lot more reticent when it comes to making end-of-life decisions.

For his community health assessment project, Chapman wanted to promote the use of health-care directives, the documents that guide physicians in caring for patients who can't speak for themselves because of debilitating injury or illness. When his research showed that less than 2 percent of patients had health-care directives on file with Staples' Lakewood Health System, he was determined to find out why—and to help improve those numbers.

Chapman distributed hundreds of questionnaires about health-care directives to patients. When he sifted through the results, he found that people gave many reasons for not having a health-care directive. Some simply hadn't committed their wishes to paper, some weren't sure where to obtain the form or how to fill it out, some figured they were too healthy to have one, and others had never heard of such directives. "I realized there was a need for education," Chapman says.

David Freeman, M.D., Chapman's RPAP preceptor, says that health-care directives give patients control over their care. "Today in medicine we can do a lot of things to people, but it doesn't mean we have to," he says. "Health-care directives are a way of giving patients choices in a crisis."

"End-of-life issues are especially relevant for primary-care doctors and their patients," says Chapman. "These physicians know their patients well and have an understanding that can allow that discussion to happen."

RPAP students are not the second, third, or fourth person behind [the preceptor] but right up in front. They're involved early on in the decision-making process.

Raymond Christensen, M.D., assistant dean for
rural health at the Medical School–Duluth Campus

To get people thinking about their options, Chapman produced a brochure and posters to be placed around the hospital that explained what health-care directives are, why they're important, and how patients could complete their own directive and file it at the hospital.

Freeman says that Chapman's project got the hospital off to a good start on an issue that needs more attention. "Now patients can pick up a flier and see what health-care directives are all about," he says. "That will get the conversation started."

Chapman, who begins his medicine/pediatrics residency at the University later this year, says the project helped him see how his expertise could bene-fit patients other than the ones he saw on a given day. "It showed me how my training can serve the needs of the larger community," he says. "And that's really valuable."  

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