DR. CHRISTENSEN: GOOD EVENING AND WELCOME TO "DOCTORS ON CALL."

I'M DR. RAY CHRISTENSEN, FACULTY MEMBER IN THE DEPARTMENT OF FAMILY MEDICINE AND BIOBEHAVIORAL HEALTH AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH CAMPUS AND FAMILY PHYSICIAN AT THE GATEWAY FAMILY HEALTH CLINIC IN MOOSE LAKE, MINNESOTA.

I AM YOUR HOST FOR OUR PROGRAM TONIGHT ON "END-OF-LIFE AND ADVANCED CARE PLANNING."

THE SUCCESS OF THIS PROGRAM IS VERY DEPENDENT ON OUR VIEWERS.

PLEASE CALL OR EMAIL YOUR QUESTIONS AND WE WILL DO OUR BEST TO ADDRESS THEM.

THE TELEPHONE NUMBERS AND EMAIL ADDRESSES FOR YOUR QUESTIONS CAN BE FOUND AT THE BOTTOM OF YOUR SCREEN.

OUR PANELISTS THIS EVENING INCLUDE, DR. JEFF COPEMAN, A FAMILY MEDICINE PHYSICIAN WITH THE FAIRVIEW MESABA CLINIC IN HIBBING.

AND DR. AMY GREMINGER, FACULTY MEMBER AT THE UNIVERSITY OF MN -- MINNESOTA MEDICAL SCHOOL, DULUTH CAMPUS AND INTERNAL MEDICINE PHYSICIAN AT ESSENTIA HEALTH.

MEMBERS OF THE WDSE STAFF ARE STANDING BY TO TAKE YOUR PHONE CALLS.

AND NOW ON TO TONIGHT'S PROGRAM.

WELCOME BOTH OF YOU.

THIS IS REALLY A GOOD PROGRAM.

AS I WAS PREPPING A LITTLE BIT, I WAS THINKING ABOUT WHY OUR INTERESTS GETS TO WHERE WE ARE.

AMY, WHAT IS YOUR INTEREST AND WHAT LEADS YOU TO AN INTEREST IN ADVANCED CARE PLANNING?

DR. GREMINGER: I THINK THAT IS A -- I KNOW IT IS ALWAYS KIND OF A CONVERSATION KILLER WHEN I MET PARTIES.

I WORK IN HOSPICE AND PALY IT IF CARE AND PEOPLE GET QUIET.

HONESTLY, IT IS A REALLY AFFIRMING CHOICE IN A PROFESSION.

TO BE ABLE TO BE WITH PATIENTS, TO HELP UNDERSTAND WHAT THEY FOR THEMSELVES, TO HELP THEM UNDERSTAND WHAT THEIR CHOICES ARE, AND THEN TO HELP GIVE THEM THEIR CHOICES.

AND TO IMPLEMENT THINGS LIKE THAT FOR THEM, IT IS A REALLY SPECIAL TIME AND SUCH AN HONOR TO BE ABLE TO PARTICIPATE IN THAT KIND OF CARE.

DR. CHRISTENSEN: DR. COPEMAN, THE SAME QUESTION.

WE HAVE HAD YOU ON HERE MANY TIMES FOR THIS SHOW.

THIS IS ONE YOU APPRECIATE AND ENJOY COMING TO.

WHAT STIMULATES YOUR INTEREST IN THIS?

DR. COPEMAN: LIKE AMY, I HAVE AN INTEREST IN END-OF-LIFE CARE AND AIR -- AND GERIATRICS.

ADVANCE CARE PLANNING IS ONE OF THEM MOST IMPORTANT THINGS THAT WE DO.

EVEN IN MY PRACTICE AS PRIMARY CARE.

ADVANCED CLICK -- ADVANCED CARE PLANNING IS SOMETHING THAT IS, I GUESS THE BEST WAY TO PUT IT IS THAT WE NEED TO KNOW WHAT PATIENT'S WISHES ARE AT THE END OF LIFE.

AND IT IS VERY COMPLICATED.

NOW WITH PHYSICIAN'S ORDERS WITH LIVING WILLS, ETC., ETC., NOW IS THE TIME WHEN PATIENTS ARE ABLE TO MAKE THE DECISION TO GET IT IN WRITING.

IN MY PRACTICE, I'VE SEEN FAMILIES TORN APART IF THERE WAS NOT ADVANCED DIRECTIVES IN PLACE WHEN A FAMILY MEMBER BECOMES VERY SICK, AND OTHERS ARE FORCED TO MAKE DECISIONS FOR THEM.

DR. CHRISTENSEN: DR. GREMINGER, MAYBE IF YOU CAN CAPSULIZE THAT AND GIVE ME MORE ON WHAT ADVANCED CARE PLANNING IS.

DR. GREMINGER: ABSOLUTELY.

ADVANCED CARE PLANNING IS A CONVERSATION.

IT IS NOT NECESSARILY ALWAYS A DESTINATION.

IT IS A GUIDED CONVERSATION WITH PEOPLE THINKING ABOUT WHAT YOUR VALUES ARE, WHAT YOUR GOALS ARE, WHAT KINDS OF TRADE-OFFS YOU ARE WILLING TO MAKE, WHAT KINDS OF THINGS ARE UNACCEPTABLE FOR YOU, AND WHO MIGHT BE A GOOD OR HELPFUL RESOURCE, IF YOU ARE NOT ABLE TO SPEAK FOR YOURSELF.

THOSE CONVERSATIONS WE HAD, YOU USUALLY START TALKING TO PATIENTS ABOUT THESE IDEAS, CLARIFYING AND GETTING CLARITY ON WHAT THOSE ARE.

THEN WE HELP THEM WRITE DOWN WHAT THEIR GOALS ARE SO THAT THE FAMILY IS NOT LEFT WONDERING, I WONDER WHAT MY LOVED ONE WOULD HAVE WANTED?

IN THE FAMILY CAN REALLY -- AND FAMILY CAN REALLY HELP UNDERSTAND WHAT THE PATIENT'S WISHES ARE.

DR. CHRISTENSEN: JEFF, WHEN SHOULD THAT BEGIN?

DR. COPEMAN: PERSONALLY, I THINK THAT SHOULD BEGIN EARLY.

JUST WHEN YOU ARE DIAGNOSED WITH A TERMINAL ILLNESS OR CHRONIC ILLNESS.

BECAUSE THINGS CAN CHANGE OVER TIME.

YOU CAN BE IN A CAR ACCIDENT IN YOUR 40'S, AND BE IN A COMA AND BE IN THE ICU.

IF THERE IS NO ADVANCED DIRECTIVES IN PLACE, THE BURDEN CAN BE PUSHED ON THE FAMILY.

I ALWAYS RECOMMEND TO PATIENTS AT LEAST IN THEIR 40'S AND 50'S TO START GOING THROUGH IT.

THEY CAN BE UPDATED AS NEEDED.

MOST PEOPLE WILL UPDATE THEIR ADVANCED DIRECTIVE ABOUT EVERY 10 YEARS.

DR. CHRISTENSEN: AMY, HOW DO YOU DO THIS?

WE ARE IN DR.-PATIENT RELATIONSHIPS ALL THE TIME.

IS THAT HOW YOU DO THAT OR DO YOU EXPAND?

WHAT IS YOUR PROCESS?

DR. GREMINGER: I THINK A LOT OF TIMES, IT IS PHYSICIAN'S THAT OPEN UP THAT DISCUSSION PEOPLE.

ONE OF THE REASONS I'M REALLY EXCITED THAT WE ARE HAVING THIS CONVERSATION IS COVID HAS CHANGED A LOT OF THINGS FOR A LOT OF PEOPLE.

EVEN THOUGH WE DON'T EXPECT YOUNG PEOPLE TO NECESSARILY HAVE THOSE LIFE-THREATENING ILLNESSES, THIS LAST YEAR HAS LED US ALL -- LET US ALL REALIZE HOW FRAGILE LIFE IS AND HOW UNEXPECTED THINGS CAN HAPPEN.

I THINK A LOT OF TIMES, PHYSICIANS WILL OPEN UP THE DOOR TO PATIENTS TO ASK IF THAT IS SOMETHING THEY ARE INTERESTED IN.

IT IS NOT NECESSARILY JUST PHYSICIANS WHO ARE ABLE TO HAVE THOSE CONVERSATIONS.

A LOT OF TIMES, NURSES WHO ARE WELL TRAINED AND HAVE THOSE CONVERSATIONS WITH PATIENTS.

IN HIS UNDERSTANDING IF PEOPLE ARE INTERESTED IN IT, AND HELPING THEM GET TO A PLACE WHERE THEY CAN HAVE A GOOD CONVERSATION ABOUT THAT.

DR. CHRISTENSEN: JEFF, WHEN YOU DO THIS, DO YOU BRING OTHER MEMBERS OF THE FAMILY INTO THIS?

HOW DO YOU HANDLE THAT PIECE?

DR. COPEMAN: IT DEPENDS ON IF THE CONTACTS IN WHICH WE ARE SEEING THE PATIENT.

A LOT OF TIMES WE WILL REVIEW THAT AT THEIR ANNUAL EXAMINATION WITH JUST THE PATIENT.

WHEN SOMEBODY IS DIAGNOSED WITH A TERMINAL ILLNESS, OR IS VERY SICK, WE WILL INVOLVE THE FAMILY TOO WHEN WE START DOING THE ACTUAL PAPERWORK.

BECAUSE IT IS A FAMILY ISSUE.

EVEN THOUGH THE PATIENT MAKES THE DECISIONS, IT IS A FAMILY DECISION.

DR. GREMINGER: I LOVE THAT IDEA, DR. COPEMAN.

I THINK ONE OF THE MOST HELPFUL THINGS, ONE OF THE THINGS WE ARE HOPING WILL COME OUT OF ADVANCED CARE PLANNING OFTEN IS, IF YOU WERE UNABLE TO MAKE THE DECISIONS FOR YOURSELF, WOULD YOU WANT THERE TO MAKE THE DECISIONS?

BUT IT IS MOST HELPFUL IF THAT PERSON WHO YOU WOULD WANT TO MAKE THE DECISIONS FOR YOU CAN BE THERE AND PRESENT FOR THAT CONVERSATION.

TO HEAR THAT DISCUSSION OF THE GOALS AND VALUES.

BECAUSE IT CAN BE REALLY CLARIFYING FOR THEM TO UNDERSTAND WHAT THAT PATIENT'S GOALS ARE VALUES ARE.

I THINK IT IS HELPFUL TO HAVE THE DECISION-MAKER INVOLVED, IF THAT IS POSSIBLE.

DR. CHRISTENSEN: I THINK OF THE DISASTERS THAT I'VE WALKED INTO, WHERE FAMILIES ARE DISPERSED.

SOMEBODY HAS NOT BEEN AROUND FOR A LONG TIME.

AND I'VE WORKED THROUGH WITH THE PATIENT, AND WITH THE LOCAL FAMILY WHERE WE ARE AT, AND THEN SOMEONE COMES IN FROM OUTSIDE WITH OTHER THOUGHTS.

THIS KIND OF PLANNING HELPS CEMENT AND AVOID THE DISASTERS THAT CAN HAPPEN FROM THAT.

DR. COPEMAN: VERY MUCH SO.

DR. GREMINGER: ABSOLUTELY.

I THINK IT LEADS TO MORE CONVERSATIONS.

SOMETIMES, I'VE BEEN IN SITUATIONS WHERE A PERSON HAS NAMED A SURROGATE DECISION-MAKER, AND THE PERSON THAT THEY NAMED IT SURPRISED THAT THAT IS THE PERSON.

THAT THEY NAMED.

.

OR MAYBE THERE ARE OTHER FAMILY MEMBERS THAT ARE SURPRISED.

YOU PICKED THIS CHILD AND NOT THAT CHILD, AND HOW IS THAT, WHY IS THAT?

I THINK HAVING THAT CONVERSATION AND BEING OPEN ABOUT THAT HELPS PREVENT SOME OF THE SURPRISES FROM HAPPENING LATER ON.

THAT IS REALLY A GIFT TO THE FAMILY, IN GENERAL.

SO THAT THERE IS ENOUGH STRESS WHEN PEOPLE ARE GOING THROUGH LIFE-THREATENING ILLNESSES, THAT THEY DON'T NEED TO NAVIGATE THAT ADDITIONAL SURPRISE STRESS.

DR. CHRISTENSEN: COVID HAS BEEN AN INTERESTING PANDEMIC IN SO MANY WAYS.

AS YOU HAVE BOTH DEALT WITH THIS, WITH ADVANCED PLANNING, ADVANCED CARE PLANNING, HAS COVID CHALLENGED THAT IN ANY WAY?

THIS WAS NOT SOMETHING THAT ANYBODY PROBABLY FORESAW.

AS THEY DID THEIR PLANNING.

NOW THEY HAVE GOT COVID.

DOES THAT CHANGE?

HOW DO YOU HANDLE THE SITUATION LIKE THAT?

DR. CHRISTENSEN: I WOULD HAVE TO SAY THAT COVID HAS-- DR. COPEMAN: I WOULD HAVE TO SAY COVID HAS BURNED A LOT OF DISCUSSIONS.

BECAUSE COVID HAS BEEN SO UNPREDICTABLE, FOR THE MOST PART.

ONE OF THE THINGS IS THAT WE CAN'T PREDICT WHO IS GOING TO GET THE SEVERE ILLNESS.

IT CAN BE ANYONE IN THEIR 20'S OR 80'S.

BECAUSE OF THE NATURE OF THE PANDEMIC, IT IS -- IT HAS BURNED A LOT OF ADVANCED CARE PLANNING DISCUSSIONS.

DR. CHRISTENSEN: ONE OF THE QUESTIONS THAT HAS COME IN IS WHAT ABOUT CHILDREN?

SHOULD YOU BE THINKING ABOUT ADVANCED CARE PLANNING FOR YOUR CHILDREN?

AS THEIR CARETAKERS?

DR. GREMINGER: YOU KNOW, I ALWAYS ENCOURAGE PEOPLE TO START EARLY.

I CERTAINLY TEACH YOUNGER PEOPLE, I DON'T TEACH 18-YEAR-OLDS, BUT PEOPLE IN THEIR 20'S.

I THINK THAT EVEN THINKING ABOUT THIS AS A YOUNGER PERSON CAN BE REALLY HELPFUL.

WITH CHILDREN LESS THAN 18, I THINK IT IS NOT NECESSARILY EXPECTED.

YOU WOULD HOPE AS A FAMILY YOU WOULD KNOW WHAT THEIR WISHES WOULD BE.

BUT NOT ALWAYS.

SO CERTAINLY IF THERE WAS A CHILD THAT HAD A SERIES ONUS, IT WOULD BE VERY HELPFUL TO TALK ABOUT SOME OF THOSE THINGS TOGETHER AS A FAMILY.

BUT THERE ARE WONDERFUL PEOPLE AND RESOURCES A LOT OF TIMES THAT -- WITH CHILDREN WITH SERIOUS ILLNESS THAT CAN HELP FOSTER GOOD CONVERSATIONS AROUND THAT.

PEOPLE LIKE CHILD LIFE SPECIALISTS THAT ARE EMPLOYED BY A LOT OF THE HOSPITAL SYSTEMS.

DR. COPEMAN: I ECHO THAT.

IF THE CHILD HAS A SERIOUS ILLNESS, ABSOLUTELY ADVANCED CARE DIRECTIVES SHOULD BE DISCUSSED WITH THE FAMILY.

DR. CHRISTENSEN: HOW DO YOU INCORPORATE THE CHILD INTO THAT?

DR. COPEMAN: A LOT OF IT IS AGE DEPENDENT, TO BE HONEST WITH YOU.

AND DEPENDING ON WHAT THE TERMINAL ILLNESS IS.

IF SOMEONE HAS CEREBRAL PALSY AND HAS LIMITED CAPACITY, AND WE CAN TALK ABOUT THE DIFFERENCE BETWEEN, DENSE AND CAPACITY TO MAKE DECISIONS, THAT WILL AFFECT THAT.

DR. CHRISTENSEN: YOU BROUGHT IT UP.

SO SEPARATE THESE TWO.

DR. COPEMAN: SURE, I WILL.

WHEN WE LOOK AT ADVACED CARE PLANNING, ONE OF THE MOST IMPORTANT THINGS IS WE WANT TO KNOW IF THE PATIENT HAS THE CAPABILITY OF MAKING THOSE DECISIONS FOR THEMSELVES.

THAT IS WHAT IS CALLED CAPACITY.

THAT MEANS YOU ARE ABLE TO DO THAT.

PATIENTS WITH DEMENTIA CAN MAKE DECISIONS REGARDING THEIR HEALTH.

IF THEY -- IF THEIR LEVEL OF DEMENTIA IS WHERE THEY STILL HAVE THE INSIGHT AND THE UNDERSTANDING OF THEIR LIVES AND THE CONSEQUENCES OF TREATMENT FOR NO TREATMENT.

SO THAT IS WHAT CAPACITY IS.

COMPETENCY IS A LEGAL TERM.

WHAT WE MEAN BY COMPETENT IS THAT THERE MAY BE PATIENTS WHO HAVE CHRONIC ILLNESS, TERMINAL ILLNESS, THAT MAY HAVE ADVANCED DEMENTIA AND THEY DO NOT HAVE THE INSIGHT TO MAKE THIS DECISIONS FOR THEMSELVES.

SO IN THAT CASE, THE JUDGE CAN DEEM THAT PATIENT INCOMPETENT TO MAKE THOSE DECISIONS FOR THEMSELVES.

THEREFORE OTHERS DO IT FOR THEM.

DR. CHRISTENSEN: THERE ARE SITUATIONS WHERE THERE ARE SPIRITUAL DIFFERENCES IN THE PARENTS.

AS TO THE CARE GIVEN.

HOW SHOULD THAT BE HANDLED, IF YOUR PRIMARY CARE FAMILY DOCTOR, HOW DO YOU HANDLE THAT SITUATION?

DR. COPEMAN: TO BE HONEST WITH YOU, THAT HAS COME UP.

THE MOST IMPORTANT THING IS ABOUT THE PATIENT.

IT DEPENDS ON THE AGE OF THE PATIENT AND IF THEY HAVE THE CAPACITY TO MAKE DECISIONS.

STILL IT IS THE PATIENT'S DECISION.

IF THEY ARE UNDER AGE, AND THEIR PARENTS ARE THEIR GUARDIANS, THAT BRINGS UP A WHOLE DIFFERENT ISSUE.

DR. CHRISTENSEN: OK. WE WILL SWITCH GEARS A LITTLE BIT.

GREAT DISCUSSION.

AMY, WHAT PERCENTAGE OF THE POPULATION DOES ADVANCED PLANNING?

DR. GREMINGER: I AM NOT SURE ON THE EXACT PERCENTAGE.

I'M -- I THINK IT VARIES BY COMMUNITIES.

THERE ARE CERTAIN COMMUNITIES, LIKE ACROSS WISCONSIN HAS A REALLY STRONG AND ROBUST COMMUNITY SYSTEM WHERE I THINK IN THAT COMMUNITY, I WANT TO SAY 90% OF PEOPLE HAVE FILLED THEM OUT.

IN OTHER COMMUNITIES, IT IS GOING TO VARY QUITE A BIT FROM THAT.

WHAT I CAN SAY IS, I DO THINK IT IS AN IMPORTANT THING TO THINK ABOUT.

FOR MANY REASONS.

BUT ESPECIALLY IN THE PANDEMIC, I THINK BEING PREPARED TO HAVE SOMEBODY THAT WOULD REALLY KNOW WHAT YOU WANT SO HELPFUL.

DR. CHRISTENSEN: EXCUSE ME, GO AHEAD.

DR. COPEMAN: I WAS GOING TO SAY, IN OUR PRACTICE, I THINK THE AMOUNT OF PEOPLE DOING ADVANCED DIRECTIVES IS INCREASING.

I THINK BECAUSE AS MUCH AS SOME OF US ARE NOT BIG FANS OF THE ELECTRONIC MEDICAL RECORD, IT MAKES -- IT DOES MAKE IT A LOT EASIER.

BECAUSE ALL OF THE THINGS WE WANT TO TALK ABOUT OUR RIGHT THERE IN FRONT OF US AS PRACTITIONERS.

THE OTHER THING IS WHEN PATIENTS ARE COMING IN FOR THEIR ANNUAL EXAMS OR ROUTINE EXAMS, BUT IS PART OF OUR INTAKE, THERE ADVANCED CARE PLANNING ON FILE AND WOULD YOU LIKE TO DISCUSS IT?

PARTICULARLY THOSE OVER AGE 65.

I WOULD HAVE TO SAY THAT IT IS INCREASING.

I DON'T KNOW WHAT THE EXACT NUMBERS WERE.

BUT IT IS INCREASING.

DR. CHRISTENSEN: LET'S GO DOWN A DIFFERENT ROAD.

WE HAVE POST PLO ST. WE HAVE DANCED CARE PLANNING.

I THINK THERE IS SOMETHING ABOUT CPR.

AND OTHER TYPES OF CARE.

IN OTHER STATES, NOT THE STATE, THAT CAN GO ALL THE WAY ON TO POSSIBLY ASSISTANCE WITH TERMINATING A BAD SITUATION IN THIS PERSON'S LIFE.

AMY?

DR. GREMINGER: I THINK THAT THAT IS A GREAT THING.

THERE IS A LOT OF UNIQUE VOCABULARY AROUND THESE DISCUSSIONS.

SO ADVANCED CARE PLANNING IS SOMETHING ANYBODY CAN DO AT ANY POINT IN TIME.

A PULSED IS A PHYSICIAN ORDER FOR LIFE-SUSTAINING TREATMENT.

THOSE ARE ACTUALLY -- IT IS DIFFERENT THAN ADVANCED CARE PLANNING.

IT IS MORE OF A CONVERSATION.

IT IS ACTUALLY PHYSICIAN ORDERS.

CLOSE ARE FILLED OUT FOR PEOPLE THAT HAVE DOCUMENTED VERY SERIOUS LIFE-THREATENING ILLNESS.

THEY ARE TYPICALLY IN THE LAST ONE TO TWO YEARS OF THEIR LIFE.

OFTENTIMES, PEOPLE THAT ARE IN NURSING FACILITIES WILL HAVE THOSE FILLED OUT, OR PEOPLE THAT HAVE SERIOUS ILLNESS.

SO THAT CAN BE A DISTINCTION.

THE OTHER THING I WANTED TO THROW IN AS A SIDE COMMENT, ONE THING YOU MENTIOED THAT I HEAR IS WHAT IF I CHANGE MY MIND?

WHERE CAN I CHANGE MY MIND?

WHAT I WOULD SAY IS PEOPLE CAN ALWAYS CHANGE THEIR MIND AT ANY POINT IN TIME.

THIS IS NOT A DESTINATION, IT IS A JOURNEY.

IT IS TRYING TO DOCUMENT WHAT YOU WANT AT THAT POINT IN TIME.

A LOT OF TIMES WHAT WE WILL DO, ESPECIALLY IF SOMEONE STARTED PLANNING YOUNGER, AS WE WILL RECOMMEND UPDATING THESE THINGS EVERY 10 YEARS OR SO.

BECAUSE PEOPLE'S GOALS CHANGE.

DR. COPEMAN: AS A CAVEAT, I MIGHT EXPLAIN AS TO WHY THE P.O.L.S.T.

CAME ABOUT.

IT IS A RELATIVELY NEW THING.

AS AMY SAID, P.O.L.S.T.

STANS FORCE OF -- STANDS FOR PHYSICIAN'S ORDERS FOR LIFE-SUSTAINING TREATMENT.

IT IS DIFFERENT THAN A LIVING WILL.

THE REASON THAT MINNESOTA IS ONE OF THE FIRST STATES THAT ADDRESSED THIS IS THAT IF SOMEBODY HAS A CATASTROPHIC ILLNESS, THEY ARE REQUIRED TO DO CPR SHOULD THE AMBULANCE, UNTIL THEY HAVE A PHYSICIAN'S ORDER.

SO IT DOES NOT MATTER IF YOU ARE A DNR DNI, IF THEY COME TO YOUR HOUSE, THEY HAVE TO DO IT UNTIL THEY GET A PHYSICIAN'S ORDER TO NOT RESUSCITATE OR TO DO ANYTHING LIKE THAT.

THE PROBLEM WITH THAT IS WHEN YOU LOOK AT COST, AND YOU LOOK AT OTHER THINGS THAT COME UP WITH THAT IS THAT WE WANTED TO BE ABLE TO HAVE THAT ORDER WRITTEN SO WHEN AN EMERGENCY PERSONNEL COMES TO YOUR PLACE OR YOUR FACILITY, THE ORDER IS SIGNED BY THE PHYSICIAN AND IS THERE, DOCUMENTING WHAT YOUR WISHES ARE.

CASE, THEY DON'T HAVE TO BEGIN CPR IS THERE.

DR. CHRISTENSEN: IS WHERE?

DR. COPEMAN: WE MAKE SURE IT IS ON THE REFRIGERATOR OR WITH THE PATIENT.

WE ALSO SCAN IT INTO THEIR MEDICAL RECORD.

IN OUR AREA, WE USE THE SAME ONE EVEN IN DULUTH.

THAT IS IN THERE.

THEY CAN CLICK ON IT AND SEE THAT IT IS THERE.

DR. CHRISTENSEN: I'M OUT OF DATE.

CAN YOU ACCESS THE MR IN THE AMBULANCE?

DR. COPEMAN: IT DEPENDS ON IF YOU HAVE RIGHTS TO DO THAT.

WE CAN DO IT ON OUR CELL PHONES.

SO IT IS BEST TO HAVE IT ON THE FRIDGE, DIFFERENT COLOR, SO THAT WHEN THEY COME IN THERE, THEY CAN LOOK OR THEY WILL ASK THE FAMILY MEMBERS, IS THERE A P.O.L.S.T.?

DR. GREMINGER: YOU MENTIONED DEATH WITH DIGNITY.

I WOULD SAY THAT IS A SEPARATE -- AGAIN, THIS COMES WITH ITS OWN UNIQUE SET OF VOCABULARY AND DESCRIPTIONS.

ADVANCED CARE PLANNING IS ONE THING.

A P.O.L.S.T.

IS ANOTHER THING.

DEATH WITH DIGNITY, SPECIFICALLY ADDRESSES'S THIS -- PHYSICIAN AID IN DYING.

IT IS NOT CURRENTLY LEGAL IN MINNESOTA.

IT IS LEGAL IN 11 STATES OR JURISDICTIONS AT THIS POINT IN TIME.

MOST FAMOUSLY, OREGON, BUT ALSO CALIFORNIA, WASHINGTON, COLORADO AND SEVERAL OTHER STATES.

AGAIN, NOT LEGAL IN MINNESOTA AT THIS POINT IN TIME.

DR. COPEMAN: YES.

AND RIGHT NOW, BECAUSE WE GET THAT IN OUR WORLD OF HOSPICE.

WE WILL GET THAT REQUEST SAYING, I KNOW I'M TERMINAL, I'M IN A LOT OF PAIN, WHY DON'T YOU JUST GIVE ME ENOUGH TO LET ME DIE?

IT IS NOT LEGAL HERE.

DR. CHRISTENSEN: I CAN SEE THE EYES OF A WOMAN, GIVE ME THE SHOT.

DR. COPEMAN: YEP.

DR. CHRISTENSEN:DR. CHRISTENSEN: THOSE ARE TOUGH.

DR. COPEMAN: VERY TOUGH.

DR. CHRISTENSEN: DO YOU WANT TO TALK ABOUT HONORING CHOICES, AND THE WEBSITE BRIEFLY SO WE DON'T FORGET IT?

DR. COPEMAN: HONORING CHOICES, IT IS A VERY WELL-WRITTEN AND I THINK DETAILED DISCUSSION OF ADVANCED CARE PLANNING.

IT HAS GOT CERTAIN PARTS IN IT THAT INCLUDES A DNR DNI, SOME OF THE OTHER WISHES THAT ARE PART OF A P.O.L.S.T., ALL IN ONE FORM.

THEY HAVE A WEBSITE.

YOU ARE ABLE TO READ THROUGH THAT.

YOU CAN DOWNLOAD THINGS.

IN MY PRACTICE, WHEN I HAVE ADVANCED CARE DISCUSSIONS, I WILL GIVE THEM A COPY OF HONORING CHOICES TO TAKE HOME AND GO THROUGH WITH THEIR FAMILY MEMBERS.

DR. CHRISTENSEN: I SEE IT IS AT THE BOTTOM OF THE SCREEN.

THANK YOU FOR PUTTING THAT UP.

ARE THERE OTHER RESOURCES THAT PEOPLE CAN GO TO TO START THIS CONVERSATION WITH A LOVED ONE?

OR IS THAT THE BEST RESOURCE?

DR. COPEMAN: I PERSONALLY USE THAT ALMOST EXCLUSIVELY.

BECAUSE I THINK IT IS VERY WELL-WRITTEN.

IT IS VERY THOROUGH.

IT COVERS PRETTY MUCH EVERYTHING.

THE PATIENTS WILL COME BACK AND WE WILL GO THROUGH IT IN DETAIL.

DR. GREMINGER: I THINK IT IS A GOOD WEBSITE AS WELL.

I WOULD SAY THAT A LOT OF DIFFERENT THINGS TEND TO SPARK CONVERSATION ON THIS.

I THINK FOR SOME PEOPLE, GO TO THIS WEBSITE CAN BE INTIMIDATING.

SOMETIMES IT COMES UP NATURALLY WITH BOOKS PEOPLE MIGHT READ OR CONVERSATION, TALKING ABOUT COVID CAN BE AN OPEN DOOR TO TALK ABOUT THIS.

IT CAN COME UP THROUGH OTHER MEANS AS WELL.

ONE OF MY FAVORITE BOOKS AND A LOT OF TIMES PEOPLE ASKED ME IF I'VE READ IS CALLED "BEING MORTAL."

IT REALLY TALKS ABOUT A LOT OF THESE ISSUES.

DR. COPEMAN: I JUST WANTED TO TOUCH ON ONE THING.

ONE OF THE MOST COMMON QUESTIONS THAT COMES UP IN OUR PRACTICE, AND I KNOW NISI'S IT TOO, WHAT DOES IT MEAN TO BE DNR DNI?

DR. CHRISTENSEN: WHAT DOES THAT MEAN?

DR. COPEMAN: THE CONCEPT IN THE PUBLIC VARIES.

SOME INTERPRET THAT AS BEING YOU ARE NOT GOING TO DO ANYTHING.

IF I SIGN THIS DNR DNI, THAT MEANS HE WILL PUT ME OUT TO PASTURE AND LET ME GO.

ACTUALLY, NOTHING CAN BE FURTHER FROM THE TRUTH.

WHAT DNR AND DNR MEANS DO NOT RESUSCITATE, DNA MEANS DO NOT INNOVATE, THAT IS LIFE SUPPORT SYSTEMS, BASICALLY THE ONE THING WE HAVE TO REMEMBER IS YOUR HEART HAS STOPPED.

THAT IS WHERE THAT TAKES EFFECT.

THAT DOES NOT MEAN WE DON'T DO TREATMENT.

THAT DOES NOT MEAN WE DON'T PUT YOU IN THE ICU.

IT DOES NOT MEAN WE DON'T ADMIT YOU TO THE HOSPITAL.

AS IF YOUR HEART STOPS, WE DON'T DO ANYTHING TO START IT AGAIN.

THAT IS A VERY COMMON MISCONCEPTION THE PUBLIC HAS.

DR. CHRISTENSEN: THERE WAS A GREAT ARTICLE, I FORGOT WHERE, BUT IT SHOWED THE EXPECTATIONS OF THE PUBLIC AND THE EXPECTATIONS OF OUR PROFESSION FOR DNR, DNI RESUSCITATION AND THE REST.

AND HOW MANY WOULD OR WOULD NOT DO THAT.

WHICH IS AN INTERESTING DISCUSSION.

I BELIEVE SOMETHING LIKE 40% OF THE PEOPLE SURVIVE ON THE SCHULTZ.

DR. COPEMAN: OH, YEAH.

DR. GREMINGER: AND IN REAL LIFE, DEPENDING ON WHERE YOU ARE, I THINK IN HOSPITAL RESUSCITATION'S, IT IS ABOUT 20% SURVIVAL.

IF YOU HAVE A SERIOUS LIFE-THREATENING ILLNESS, AND THAT INCLUDES DEMENTIA OR CANCER OR REALLY SERIOUS HEART FAILURE, THE CHANCES OF SURVIVING TO EXIT THE HOSPITAL OFTEN TIMES ARE LESS THAN 1%.

THAT REALLY DOES MOVE WHERE A LOT OF PEOPLE WANT TO BE, KIND OF KNOWING THE ODDS.

A LOT OF TIMES, IT IS VERY DIFFERENT THAN WHAT PEOPLE SEE ON TV OR WHAT PEOPLE MIGHT EXPECT.

DR. CHRISTENSEN: JEFF, A HITTING CALL, IS THERE A DIFFERENCE BETWEEN ADVANCED CARE PLANNING AND POWER OF ATTORNEY?

DR. COPEMAN: YES.

IF I MIGHT EXPLAIN THAT, ADVANCED CARE PLANNING IS A GLOBAL THING, WHICH INCLUDES A LOT OF DIFFERENT PARTS.

THAT INCLUDES THE DNR DNI, THAT INCLUDES SOMETHING CALLED A LIVING WILL, THAT INCLUDES POWER OF ATTORNEY.

ALL OF THAT IS PART OF HONORING CHOICES.

IF I MIGHT EXPLAIN WHAT THAT IS.

WHAT A POWER OF ATTORNEY IS, IT IS NOT THE POWER OF ATTORNEY FOR FINANCES.

WE ARE TALKING ABOUT THE POWER OF ATTORNEY FOR MAKING MEDICAL DECISIONS.

THAT IS SOMEONE THAT YOU DESIGNATE OR BY LAW, IF YOU ARE NOT ABLE TO MAKE THAT DECISION, THE NEXT OF KIN MAKES THOSE DECISIONS FOR YOU.

THAT IS WHAT A POWER OF ATTORNEY IS.

SOMETHING CALLED A DURABLE POWER OF ATTORNEY OF HEALTH CARE THAT WE GO THROUGH.

DR. CHRISTENSEN: CAN YOU CLARIFY THE DIFFERENCE BETWEEN HEALTH CARE DIRECTIVE AND P.O.L.S.T.?

DR. GREMINGER: ABSOLUTELY.

I WOULD SAY THAT HEALTH CARE DIRECTIVE IS KIND OF THE BIGGER CONVERSATION ABOUT WHO MIGHT HELP OUT WITH HEALTH CARE DECISIONS, WHAT ARE YOUR GOALS, WISHES, WHAT WOULD YOU WANT IN CASE OF A CATASTROPHIC ILLNESS?

IT IS THAT BIGGER CONVERSATION AND THAT CLARIFICATION.

A P.O.L.S.T.

IS A VERY SPECIFIC FORM THAT IS FOR PEOPLE IN THE LAST ONE TO TWO YEARS OF THEIR LIFE, AND THOSE ARE ACTUALLY PHYSICIAN ORDERS THAT SAY, IF SOMEBODY'S HEART STOPS, THIS IS WHAT THEY WANT US TO DO.

THE ANSWER COULD BE TO DO CPR, OR IT COULD BE TO NOT DO CPR.

IT IS NOT NECESSARILY SAY WHAT THE ANSWER IS.

IT IS THE FORM THAT TALKS ABOUT WHAT THE QUESTIONS ARE.

DR. CHRISTENSEN: A 32ND QUESTION.

IS THERE A DIFFERENCE OR A STIGMA AROUND ADVANCED CARE PLANNING, IS THERE A STIGMA AROUND ADVANCED CARE PLANNING?

DR. COPEMAN: I WOULD HAVE TO SAY THAT SOMETIMES WHEN YOU BRING UP THE CONVERSATION OF ADVANCED CARE PLANNING, THERE CAN BE A STIGMA BECAUSE THEY ARE SAYING, WHAT DO YOU MEAN?

AND I DIE?

MY VERY SICK?

DASHCAM I VERY SICK?

-- AND I VERY SICK?

WE ARE TRYING TO MAKE PLANS IF SOMETHING SHOULD HAPPEN.

I THINK THERE IS A STIGMA AROUND THAT.

DR. CHRISTENSEN: WHAT A GREAT EVENING.

AMY AND JEFF, THANK YOU SO MUCH FOR COMING IN.

I WANT TO THANK OUR PANELISTS, DR. JEFF COPEMAN AND DR. AMY GREMINGER AND OUR WDSE PHONE VOLUNTEERS.

PLEASE JOIN DR. PETER NALIN NEXT WEEK FOR A PROGRAM ON "ALLERGIES, ASTHMA, COPD AND LUNG PROBLEMS" WHEN HIS PANELISTS WILL BE DR. WANE ELMER AND DR. JASON WALL.

THANK YOU SO MUCH FOR WATCHING.

HAVE A GREAT EVENING.