How to Be An Advocate for Life Care Planning Patients
I’ve spoken before about my journey from physiatry — working as a Rehabilitation Physician — to my current role as a Life Care Planner (in addition to my medical duties.) Now, I want to talk briefly about how the two roles differ. A doctor and an individual working in life care planning must view their patients quite differently at times. Both viewpoints are equally important in ensuring that the patient receives the best of care.
My Work as a Doctor
I have worked as a physical medicine physician since 1990. As all doctors do, I took the Hippocratic Oath to heart. Here is a translation of the original Greek, followed by the modern version we take today (with thanks to Wikipedia):
“I swear by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.
I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.”
Now, the modern version. It has gone through numerous edits, as recently as 2019:
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will protect the environment which sustains us, in the knowledge that the continuing health of ourselves and our societies is dependent on a healthy planet.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
I use the oath to illustrate the responsibility I carry for every one of my patients. The first rule in my work as a physician is to do no harm, but just as importantly, I must serve as an advocate for everyone I treat.
My Work as a Life Care Planner
Life care plans are care plans for life. These are living documents; they determine long-term care requirements for people suffering from chronic and permanent medical conditions. These plans are case management tools used in the doctor’s office, by specialists, by insurance companies, by trusts, and by the courts. They outline costs, goods, and services.
A life care plan is a single source of the truth. That truth cannot be swayed by anyone’s feelings; not mine, not the patient’s, anyone. When I am working in that capacity, therefore, I must be an advocate for the TRUTH.
It is not uncommon to be called as a defense witness to defend my own life care plan, prepared for someone injured and suffering. In other instances, I am called to court to testify on a case in which I did not prepare the life care plan, but am needed to serve as an expert. I must educate, not advocate.
The bottom line is that bias has no place in life care planning work. Bias harms court proceedings and can result in suboptimal results for the patient. Opposing counsel — the folks on the other side — work to paint opposing experts as biased. The skills of any successful life care planner are put to the test on a frequent basis in a court of law.
So, what is the difference between my work as a physician and as a life care planner? It’s important to note the similarities before I conclude: that everything I do in BOTH roles is evidence-based. I must arrive at opinions based on factual information, and based on those facts, conclusions are formed. Foundation and methodology is important! Otherwise, my work is not reliable and won’t make it into a court of law.
The difference is based on advocacy. As a doctor, I advocate for the patient.
As a life care planner, I advocate for the truth.
To learn more about life care planning and how a life care plan can help someone in your life, contact my office now.