She strongly believes that healthcare needs to change to benefit the patient and has traveled, lived, and volunteered medically in over 40 countries, equipping her to offer culturally competent care to all ethnic backgrounds. She has led multiple medical volunteer trips internationally and embarked on the World Race before medical school and works part-time for an anti-sex trafficking agency. She has also participated in additional training in healthcare related to LGBTQI needs and gladly accepts patients from any walk of life. In the future, she wishes to offer counseling and therapy to her patients. In her free time, Dr. Kelvas practices yoga, mindfulness meditation, and travels. She owns a medical writing company and is currently writing a book on PTSD in healthcare providers.
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When should the family doctor step in?
Ideally, the conversation should be started well before the patient is incapacitated and still in good mental health; I know that in the setting of stroke for example, this isn’t always possible. It’s really important to have an advanced directive in case something tragic does occur suddenly. For my older patients, or those suffering from end-stage chronic disease, I try to give them a realistic timeline, and compassionately ask the question, “What would you like in the end?” I explain the difference between hospice and palliative care LONG before the patient needs it. Often the desires of family do not align with those of the patient, so I want to give them a chance to decide before the pressure and pain comes.
What are the protocols?
No set protocol. In the perfect world, the patient already has a solid, personal relationship with their doctor, so they can discuss at length. This is why I can’t stress enough the importance of having a family medicine physician that you see yearly. Establish a relationship with your doctor before you need it!
Is there a medicare code?
Health”care” is a business, so yes, there exist codes for literally everything. This will depend on the patients diagnoses. I recommend patients try to find a direct primary care model, where physicians can chart and take care of patients outside of insurance company restrictions (where I fled after becoming burnt out over mainstream healthcare, so I could return to the art of medicine). The more complicated and long the diagnosis, the more insurance will reimburse.
What is the communication flow with family and loved ones?
Controversial question, as culture, religion, and family hierarchy can drastically change communication. Some cultures allow the children to make all the decisions, and keep the negative details a secret persay from the patient, believing that speaking negativity breathes life into the poor health outcome. This is out of respect for their culture. Having lived and traveled to over 40 countries, I’ve learned how to offer culturally-competent care (an important quality to look for in a physician). Things become difficult unfortunately, when the wishes of the patient starkly contrast those of the family. As a physician, in the end, we should always respect patient autonomy and justice. Respect what your patient wants, as long as they’re in their right mind. One day, you too will be in that position, and will hope desperately that someone listens to you in the end.
Transscript:
Hi there, it’s Dr. calvus with Liberty Family Medicine here to talk to you about what is the physician role in long term care education and planning for for your elderly. So I ideally, this conversation needs to be started, you know, well before your family member is incapacitated, sick, you know, before they have a stroke. Having worked in the ER, though I know that this is often not possible, because a lot of times it’s an emergent situation, you’ve had no time to plan. First. So I think the first thing is, it’s very important to have an advanced directive, you know, ask the patient ask your mom or your dad, you know, what, what do you want? Do you want to be intubated? Do you want all the aggressive measures? Do you want CPR Do you want, you know, ICU care, depending on their chronic illnesses, for example, if they’ve been, you know, battling terminal cancer for a long time, they may not want all of that. And you have to respect that decision. That’s actually one of the four tenants of health care that all physicians learned in medical school is how to respect patient autonomy. So ask them, have them write it out in an advanced directive? Also, you know, ask ask your doctor, especially if you’re suffering from like a chronic long term illness like Chronic kidney failure. Ask for a realistic timeline. And physicians are not wizards. Right. We can’t necessarily predict the future. But I think it’s beneficial for sure to know, okay, does my mom or dad have one month? Do they have one or two years? And then asking them okay, well, what would you like in the end, hospice palliative care, and long term care facilities, they are not all the same things. And so it’s very important that you understand the difference Hospice is when you when you really are at the end, you’ve got maybe a couple days, I think it’s max six months to live. And at that point, physicians are not giving you any life saving medications, it’s literally just to make you comfortable. Palliative care is a little bit longer, they may
choose.
But again, it just also depends on your insurance, and how much they’ll they’ll cover for I know, a lot of my patients really prefer home hospice care. And you know, but again, that may be very distressing for the family, or you know, so things again, just to talk about with your physician. Another another role of a physician is we tend to kind of be the, the middleman because often the sick family member and the family do not want the same things. And so being you know, having, again, patient autonomy, respecting what they want, but you know, also appreciating, okay, well the rest of the family may have to take care of you, is this something that they can financially handle, or you know, someone gonna have to quit their job and stay home. So sometimes actually getting a counselor or somebody might might be more beneficial and having regular council sessions. Um, something else that’s really important, though, before any of these conversations even happen, you need to have a good relationship with a physician. I know right now, it’s hard to find a primary care doctor. But it you know, like, at least with me, you know, I’m learning my patients. And I know, I know what they like or what they don’t like, or, you know, patients just want to be told what to do versus if they’re the kind of people that want, you know, all the numbers or all the details. And, and I think there’s so much healing that happens in that therapeutic alliance, that you can’t you can’t bill for that. Right? Like, you can’t, you can’t put your finger on it. But having a physician or health care provider that just listens and kind of understands your needs, I think helps make that transition, you know, through through end of life so much easier. So yeah, just to kind of summarize I think having having a good counsel, have a Advanced Directive, have a good relationship with your physician beforehand, and then also asking your family members you know, truly what, what do you want in the end
