It can be pretty unpleasant to think of a time when a loved one, or even you, are very sick or injured.
Because we can't plan for the unexpected, it's that much more important to have a health care plan in place.
Advanced care planning – whether you're young and healthy or you're worried about aging parents – is an essential and sometimes difficult subject.
Dr. Sonia Karimi is a family medicine and palliative care physician with Allina Health and can help guide us through how to have that conversation comfortably and helpful resources.
Selected Podcast
Advance Care Planning: Making Your Health Care Wishes Known
Featured Speaker:
Sonia Karimi, MD - Family Medicine/Palliative Medicine
Dr. Sonia Karimi is a physician board-certified in both family medicine and palliative care with professional interests in palliative medicine, adolescents, nutrition, sports medicine and geriatrics. She is an exercise enthusiast, having completed many triathlons and an Ironman finisher. Dr. Karimi's approach to care is one of shared-decision making and says she takes the time to listen to her patients concerns, develop treatment plans and provide education instead of rushing them out the door. Transcription:
Advance Care Planning: Making Your Health Care Wishes Known
Melanie Cole (Host): It can be pretty unpleasant to think of a time when a loved one, or even you, are very sick or injured. And because we can’t plan for those unexpected moments, it’s much more important to have a healthcare plan in place. My guest today is Dr. Sonia Karimi. She’s a family medicine physician and palliative care specialist with Allina Health. Welcome to the show, Dr. Karimi. What is advanced care planning?
Dr. Sonia Karimi (Guest): Thanks, Melanie. Well, I think of advanced care planning really as a process rather than an event. It’s a process that involves the discussion with your healthcare provider, your family, and the patient, and it’s the process of designing your goals, values and hopes for not only your health but how you want to live your life and what you want to see in your future as you age.
Melanie: This is a tough thing to do. As we said in the intro, it’s a tough subject to bring up. What are the steps involved in advanced care planning and how specifically do you bring it up to your loved ones?
Dr. Karimi: Well, I agree that’s a very hard thing to bring up. I’ve tried to get my parents to do it – and I’m a specialist – and it’s still been a challenge. There are multiple ways you can do it, and I think you can just start that with a discussion. Often, these discussions can be prompted by a health event that happens to someone close to you. That can be a good chance for children to say to their aging parents, “Hey, mom, if you were in this situation, what would you want?” Or, “What do you think about this?” So, they can often be a way to approach the subject in a manner that’s more natural and feels less intimidating to our aging parents. But it’s a discussion, and your healthcare provider can help facilitate it with you in the office. You can also go to classes, but just starting the discussion about what’s important to you as you age, what you would or wouldn’t want if that event happened. And then, the final piece is just documenting that discussion. I really think that the conversation is more important than the actual filling out of the form.
Melanie: The types of questions, the ones that are so difficult, and there are some barriers to advanced care planning, in that there is denial, and as you even say, your relatives and mine as well. There are these barriers. They are in denial. They don’t want to talk about it. It’s not going to happen to them. So, what types of questions should you be thinking about during these discussions and you said, “Keep track. Write down these questions and the answers so that you have them all.” What are the questions?
Dr. Karimi: Well, I think the most important ones, if you had a big health event in which you were, for example, in the ICU requiring life-sustaining interventions like a ventilator or things like that, if you couldn’t speak for yourself, what would you say? When people don’t want to talk about it, I tell them, “It’s a way of honoring your goals and wishes even if you can’t tell us what they are.” And sometimes, I’ll try to make light of it by saying, It’s like getting flood insurance. You hope that you never have to use it, but you’re really happy when you do have it. But it’s a way of really being able to honor you even if you can’t communicate what you want.” And so specifically, it would be around, something very bad happened and you needed kind of intensive life-sustaining treatments: Is that something you would want to continue? Is that something that you would want to be able to be allowed to die naturally? Those sorts of things are very important. And also, things like if the doctors are able to tell your loved ones or your decision-makers that your life is not going to be anywhere near the same it was before this health event or this accident, is that a life that you would want to continue to live, or would you want to be allowed to die naturally, rather than live in a debilitated state, or depending on machines to keep you alive; things like that?
Melanie: If you think about those final days, and this is an important one, I feel, because you’re talking about, would you rather be at home? And then, organ donation is an important one, funeral arrangements. I mean, how do you ask somebody “What type of funeral would you like?”?
Dr. Karimi: Yeah, exactly, it is a hard thing. And that’s why sometimes it’s just not something that’s going to be an easy conversation that’s going to happen between children and their parents, or the patient and whoever their healthcare agent would be. And in all situations, we – Allina, for example, has classes that you can come to and it makes it a little bit less serious. Like, “Okay, I’m just filling out a will where you…” People don’t seem to have a problem filling out wills at first. Like if something happens, who would get my house? And things like that. But when it comes to their health, obviously, it makes them a lot more nervous. They’ll be able to just go to a class and say, “Here’s a bunch of other healthy people. We’re all going to go through it: fill out this form together.” It can make some of the decisions easier to do and make the process seem less morbid. But otherwise, it’s also something that your doctor should be bringing up as well, because patients don’t want to bring it up. And so, your primary care physicians, oncologist, the ICU doctors, they should be bringing it up as well, because it is a hard thing for children to talk about to their parents with. But, yeah, I agree. It’s important to be able to document things, especially with our cancer patients. One of the things I always as them is, “If you know your time is limited, which unfortunately is going to be limited, how do you want to spend it? Do you want to be home? Do you want to be in the ICU? And then, after you’re gone, how do we want to honor you? For a lot of people, organ donation is one way of being able to honor their loved one and can provide a lot of comfort to families when they’ve lost a loved one. Those things are very important and a lot of it is just the language that you use in approaching these topics.
Melanie: Dr. Karimi, when you’re picking your agent -- because you mentioned picking your agent, and I’d also like to ask you how long these directives last – but when you’re picking your agent, suppose you’re the one who’s making your advanced care planning and you have more than one child, how do you decide who’s the toughest, who’s going to be able to make those tough decisions, or not be overemotional about it? That’s going to be important as to who you pick to make these decisions for you.
Dr. Karimi: Yeah, you’re exactly right, Melanie. Often I’ll have patients say, “I want all my children know what I want and they can just make a decision together.” I love the idea behind that, because family is important as a unit. But what I usually say is, “It’s going to be a lot easier on your children if you just pick one. And obviously, you hope that that healthcare agent kind of looks to the rest of them and makes a decision that everyone feels good about, but it is easier if there’ just one.” And I always say, “Which of your children, or whoever you want for you healthcare agent – it’s often children – is going to be the best under stress and, most importantly, maybe the least emotional?” Because when your parents are sick or your loved ones are sick, it’s very hard not to be emotional and it’s so hard to make decisions in that state. But thinking about which of your children is going to be able to step back, kind of look at the big picture and make a decision, and more importantly, make decisions based on what they think you will want and not what they would want, because none of us want to lose our parents, and so, it’s really hard to separate. As healthcare agents, one of the hardest things to do is separate what you want and what you think your loved one would want. That’s a hard thing to do. So thinking about the child that you feel would be best able to do that.
Melanie: That’s a great point to make sure that it’s what your loved one wants and not what you yourself, based on emotions, want. Give us some resources, Dr. Karimi, for additional information about advanced care planning.
Dr. Karimi: And in quick response, your healthcare directive doesn’t expire. It’s something that lasts as long as it’s there, but you can change it at any time. As far as resources, at Allina Health, we have trained facilitators that will meet with you, like I talked about, either one-on-one or as part of classes. You can also go to the Allina website, allinahealth.org/ACP, which stands for advanced care planning. Sometimes, you can talk to your primary care provider about. If you google advanced care planning, there’s a lot of different good sites, like Honoring Choices. There’s a lot of great resources out there. It’s just a matter of asking for them.
Melanie: So you can get some free classes at allinahealth.org/ACP, or you can call 612-262-2224 to register for the free classes to help set up advanced care planning directives. And in just the last minute or so, Dr. Karimi, tell us why listeners should come to Allina Health for their primary care.
Dr. Karimi: Well, I think Allina is very patient-centered. I think whenever you’re looking to get a good healthcare outcome, whether it’s for a minor illness or something significant, it’s a way of having two experts involved; having the medical provider, who’s an expert on the medicine, and then the patients themselves is the expert on their goals and their values. And when you combine these two things, you’re going to get the best outcome for your health. I think Allina really values that process and really looks at the patients as experts themselves.
Melanie: That’s such great information. You’re listening to The Wellcast by Allina Health. And for more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thank you so much for listening.
Advance Care Planning: Making Your Health Care Wishes Known
Melanie Cole (Host): It can be pretty unpleasant to think of a time when a loved one, or even you, are very sick or injured. And because we can’t plan for those unexpected moments, it’s much more important to have a healthcare plan in place. My guest today is Dr. Sonia Karimi. She’s a family medicine physician and palliative care specialist with Allina Health. Welcome to the show, Dr. Karimi. What is advanced care planning?
Dr. Sonia Karimi (Guest): Thanks, Melanie. Well, I think of advanced care planning really as a process rather than an event. It’s a process that involves the discussion with your healthcare provider, your family, and the patient, and it’s the process of designing your goals, values and hopes for not only your health but how you want to live your life and what you want to see in your future as you age.
Melanie: This is a tough thing to do. As we said in the intro, it’s a tough subject to bring up. What are the steps involved in advanced care planning and how specifically do you bring it up to your loved ones?
Dr. Karimi: Well, I agree that’s a very hard thing to bring up. I’ve tried to get my parents to do it – and I’m a specialist – and it’s still been a challenge. There are multiple ways you can do it, and I think you can just start that with a discussion. Often, these discussions can be prompted by a health event that happens to someone close to you. That can be a good chance for children to say to their aging parents, “Hey, mom, if you were in this situation, what would you want?” Or, “What do you think about this?” So, they can often be a way to approach the subject in a manner that’s more natural and feels less intimidating to our aging parents. But it’s a discussion, and your healthcare provider can help facilitate it with you in the office. You can also go to classes, but just starting the discussion about what’s important to you as you age, what you would or wouldn’t want if that event happened. And then, the final piece is just documenting that discussion. I really think that the conversation is more important than the actual filling out of the form.
Melanie: The types of questions, the ones that are so difficult, and there are some barriers to advanced care planning, in that there is denial, and as you even say, your relatives and mine as well. There are these barriers. They are in denial. They don’t want to talk about it. It’s not going to happen to them. So, what types of questions should you be thinking about during these discussions and you said, “Keep track. Write down these questions and the answers so that you have them all.” What are the questions?
Dr. Karimi: Well, I think the most important ones, if you had a big health event in which you were, for example, in the ICU requiring life-sustaining interventions like a ventilator or things like that, if you couldn’t speak for yourself, what would you say? When people don’t want to talk about it, I tell them, “It’s a way of honoring your goals and wishes even if you can’t tell us what they are.” And sometimes, I’ll try to make light of it by saying, It’s like getting flood insurance. You hope that you never have to use it, but you’re really happy when you do have it. But it’s a way of really being able to honor you even if you can’t communicate what you want.” And so specifically, it would be around, something very bad happened and you needed kind of intensive life-sustaining treatments: Is that something you would want to continue? Is that something that you would want to be able to be allowed to die naturally? Those sorts of things are very important. And also, things like if the doctors are able to tell your loved ones or your decision-makers that your life is not going to be anywhere near the same it was before this health event or this accident, is that a life that you would want to continue to live, or would you want to be allowed to die naturally, rather than live in a debilitated state, or depending on machines to keep you alive; things like that?
Melanie: If you think about those final days, and this is an important one, I feel, because you’re talking about, would you rather be at home? And then, organ donation is an important one, funeral arrangements. I mean, how do you ask somebody “What type of funeral would you like?”?
Dr. Karimi: Yeah, exactly, it is a hard thing. And that’s why sometimes it’s just not something that’s going to be an easy conversation that’s going to happen between children and their parents, or the patient and whoever their healthcare agent would be. And in all situations, we – Allina, for example, has classes that you can come to and it makes it a little bit less serious. Like, “Okay, I’m just filling out a will where you…” People don’t seem to have a problem filling out wills at first. Like if something happens, who would get my house? And things like that. But when it comes to their health, obviously, it makes them a lot more nervous. They’ll be able to just go to a class and say, “Here’s a bunch of other healthy people. We’re all going to go through it: fill out this form together.” It can make some of the decisions easier to do and make the process seem less morbid. But otherwise, it’s also something that your doctor should be bringing up as well, because patients don’t want to bring it up. And so, your primary care physicians, oncologist, the ICU doctors, they should be bringing it up as well, because it is a hard thing for children to talk about to their parents with. But, yeah, I agree. It’s important to be able to document things, especially with our cancer patients. One of the things I always as them is, “If you know your time is limited, which unfortunately is going to be limited, how do you want to spend it? Do you want to be home? Do you want to be in the ICU? And then, after you’re gone, how do we want to honor you? For a lot of people, organ donation is one way of being able to honor their loved one and can provide a lot of comfort to families when they’ve lost a loved one. Those things are very important and a lot of it is just the language that you use in approaching these topics.
Melanie: Dr. Karimi, when you’re picking your agent -- because you mentioned picking your agent, and I’d also like to ask you how long these directives last – but when you’re picking your agent, suppose you’re the one who’s making your advanced care planning and you have more than one child, how do you decide who’s the toughest, who’s going to be able to make those tough decisions, or not be overemotional about it? That’s going to be important as to who you pick to make these decisions for you.
Dr. Karimi: Yeah, you’re exactly right, Melanie. Often I’ll have patients say, “I want all my children know what I want and they can just make a decision together.” I love the idea behind that, because family is important as a unit. But what I usually say is, “It’s going to be a lot easier on your children if you just pick one. And obviously, you hope that that healthcare agent kind of looks to the rest of them and makes a decision that everyone feels good about, but it is easier if there’ just one.” And I always say, “Which of your children, or whoever you want for you healthcare agent – it’s often children – is going to be the best under stress and, most importantly, maybe the least emotional?” Because when your parents are sick or your loved ones are sick, it’s very hard not to be emotional and it’s so hard to make decisions in that state. But thinking about which of your children is going to be able to step back, kind of look at the big picture and make a decision, and more importantly, make decisions based on what they think you will want and not what they would want, because none of us want to lose our parents, and so, it’s really hard to separate. As healthcare agents, one of the hardest things to do is separate what you want and what you think your loved one would want. That’s a hard thing to do. So thinking about the child that you feel would be best able to do that.
Melanie: That’s a great point to make sure that it’s what your loved one wants and not what you yourself, based on emotions, want. Give us some resources, Dr. Karimi, for additional information about advanced care planning.
Dr. Karimi: And in quick response, your healthcare directive doesn’t expire. It’s something that lasts as long as it’s there, but you can change it at any time. As far as resources, at Allina Health, we have trained facilitators that will meet with you, like I talked about, either one-on-one or as part of classes. You can also go to the Allina website, allinahealth.org/ACP, which stands for advanced care planning. Sometimes, you can talk to your primary care provider about. If you google advanced care planning, there’s a lot of different good sites, like Honoring Choices. There’s a lot of great resources out there. It’s just a matter of asking for them.
Melanie: So you can get some free classes at allinahealth.org/ACP, or you can call 612-262-2224 to register for the free classes to help set up advanced care planning directives. And in just the last minute or so, Dr. Karimi, tell us why listeners should come to Allina Health for their primary care.
Dr. Karimi: Well, I think Allina is very patient-centered. I think whenever you’re looking to get a good healthcare outcome, whether it’s for a minor illness or something significant, it’s a way of having two experts involved; having the medical provider, who’s an expert on the medicine, and then the patients themselves is the expert on their goals and their values. And when you combine these two things, you’re going to get the best outcome for your health. I think Allina really values that process and really looks at the patients as experts themselves.
Melanie: That’s such great information. You’re listening to The Wellcast by Allina Health. And for more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thank you so much for listening.