Healthy Wealthy & Wise Dr. William T. Choctaw, MD, JD
The Healthy Wealthy and Wise Podcast, with Dr. William T. Choctaw, MD, JD is a monthly podcast that focuses on personal growth and development by exploring a range of topics related to mental and physical health, personal wealth, leadership, and interpersonal relationships. Dr. Choctaw draws on his 75yrs experience and 50 plus years of surgical practice since graduating from Yale University School of Medicine.
Each month, we strive to provide our listeners with mental, physical, and spiritual strength by giving actionable advice, tips, guidance, and information to help them achieve their own personal, professional, and spiritual goals. We consider the health of the mind, body, and spirit paramount as a single unit that provides a cumulative strength greater than the individual parts, to strengthen the whole person.
We appreciate the natural differences in need between men, women, adults, and children. We recognize that the power to be happy is within each of us and under our control. We embrace technology and identify how it is applicable to our daily success. We address the entire human experiences from generation z to the baby boomers.
We’re passionate about the total person, and helping our listeners build and lead a full, well-rounded and happy life. So, tune in every month for an inspiring, encouraging, and informative podcast!
Healthy Wealthy & Wise Dr. William T. Choctaw, MD, JD
Mastering Your Healthcare Decisions: A Comprehensive Guide to Advanced Directives with Dr. William Choctaw
Want to take control of your healthcare decisions? Join us as we open the door to the crucial world of advanced directives with Dr. William T Choctaw. Together, we guide you through the labyrinth of these legally binding documents, from living wills to medical power of attorney, dissecting their intricacies and importance. We discuss how hospitals are obligated to ask about these directives to ensure your personal needs are met and why validating these documents is a must.
Moving onto the tough subject of end-of-life discussions, we share Dr. Choctaw's invaluable wisdom on how to navigate these delicate conversations. We delve into the role an appointed agent plays in making decisions on a patient's behalf, and the various aspects you need to consider. Wrapping up the episode, Dr. Choctaw leaves us with his inspiring five principles for life and your cue to continue your journey of discovery with our Health, Wealth, and Wise Podcast. Don’t miss this opportunity to gain essential insights and become the master of your healthcare decisions.
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The Host, Dr. William Choctaw; MD, JD, is a healthcare leadership expert, possessing a Medical Doctorate from the Yale University School of Medicine, and a Jurist Doctorate from Western University. Over a span of 50 years practicing medicine, he has served as Chief of Staff, Chief of Surgery, and as a member of the medical executive committee at Citrus Valley Medical Center over a 10 year period. Also, while practicing at Citrus Valley Medical Center, he served as Chief Transformation Officer, (developed a Robust Process Improvement/Lean Six Sigma program). Dr. Choctaw lectures nationally and internationally on medical leadership issues for hospital staffs, executives, and managers. He served as a Physician Surveyor on the Joint Commission. He's the author of 2 books, "Medical Malpractice: A Physician's Guide to the Law" and "Transforming the Patient Experience: A New Paradigm for Hospital and Physician Leadership, published by the Springer Publishing Co. He’s the President of Choctaw Medical Group, Inc., a clinical practice and medical legal consulting firm for medical staff executives, physician leaders, and hospitals.
Welcome to the Healthy, wealthy and Wise podcast with Dr William T Choctaw, mdjd, where the doctor helps you unlock your full potential by equipping you with tools and knowledge in the areas of health, wealth and wisdom anchored in his experience as a business executive, a physician surveyor for the Joint Commission, a former mayor and over 50 years of experience as a general surgeon. You've got questions, he's got answers, so let's get started. Here's Dr William T Choctaw, mdjd.
Speaker 2:So what are some types of advanced directives? Living will is a type of advanced directive. A will is where individuals say what they want done, as after they pass on, healthcare-powered. Returning again is another type of advanced directives. So let's look again at definitions. So it is a way that individuals can say what they want, what they want done in terms of their healthcare. That can also be expanded, by the way, and it could be a will itself.
Speaker 2:Now, many times the way the law applies to these types of fit situations will vary depending on which state you're in, so keep that in mind. I'm in the state of California, so when I talk about the legal issues and I'll try to always identify that I'm talking about the legal issues as it applies in the state of California. If you're in New York or Florida or Alabama, mississippi, chicago, these it may very well be different for you, so please consult your local legal authority in terms of how the law applies, but the definitions are basically the same. Then an advanced directive is offered throughout the country and indeed one of my responsibilities after I had finished active practice and I was involved with working with the Joint Commission as a position surveyor in the hospital side is to make sure that all hospitals would ask the question of every single admitted patient do you have an advanced directive? And we would encourage them to follow up with that. If you do not, would you like one, and if so, we can help you. So my point is that this is universal throughout the country, all 50 states. Hospitals are required to ask about advanced directives and or assist patients who are admitted to create their own advanced directive. But you can put anything you want in an advanced directive and you can have it be as limited or as broad as you want. Some individuals may want to include financial information in their advanced directives or general information in their advanced directives. It really is suited to the individual patient, but for our purposes today, we're going to talk about it as it relates to health care within the hospital for the most part.
Speaker 2:So, as we said, it's also, in the state of California at least, it's called a living will or a medical power of attorney, so it is a legal document that has certainly has authority. It has legal authority and, again, the who would be interested in having an advanced directive would be an older adult or someone with severe chronic illness. So how do you do an advanced directive, well, it should be in writing because, again, remember, we say it's a legal document and the good way to think about that is, when we said legal, we mean something in writing, and in addition to being in writing, there has to be a validation process of the writing. So there are two steps here with an advanced directive. Patient Jones decides that she must have certain things done or not done if she gets to certain stages with her illness, and so she wants to put it in writing and someone can record that for her. But the second part of that is there must be that writing must be validated, and we'll talk about specifically what that means. So an advanced directive again is a legal document.
Speaker 2:Now it does not have to be fancy. One can just sit down and dictate and or write what they want with a pen, or you can easily go online and put in advanced directives and a number of sample documents would appear and you can go by those guidelines. What I encourage patients to do is, when you go to your regular doctor's appointment or if you are being admitted to the hospital for some reason, let them know that you would like to have an advanced directive. Now they're supposed to ask you anyway, but just for the sake of what you let them know, or if you were going with your parent or your grandparent and you had that discussion with them, just say my mom would be interested in setting up an advanced directive or my father would be interested in setting up an advanced directive. But that's probably the best way to approach this Because as a physician, as a surgeon, I have certainly been in situations where there was no advanced directive and usually the circumstances would be there are multiple children taking care of the multiple children in the family.
Speaker 2:Usually there's one child, son or daughter who has taken care of mom or dad or grandma or granddad, but let's say mom or dad and other siblings or other parts of the country, other parts of the world. But when mom gets sick, everybody flies in and then everybody wants to be a part of what's done and not done with mom or dad or with the patient. However, if the patient is asked prior to having a severe sickness or illness what they would like done or not done, it significantly simplifies that process. And again you can extend it beyond healthcare to a living will, to assets, et cetera, et cetera. It could be as limited or as large as you want, but for our purposes today we're talking about healthcare and what medical treatment the patient wants or does not want. But again, going back to my mother-in-law, she clearly knew what she wanted and what she did not want. And what she did not want is she did not want to live to be a hundred because she felt that her abilities would be so diminished that she just did not want that. And I had to learn to respect that. I had to learn to respect that.
Speaker 2:So one of the things about validation of that written document which we call in advanced directives, which are our directions in advance about what a patient wants with their health care, particularly do an end of life situations and one of the things about that document is that it must be signed. Now, as with a lot of legal types of, nothing is simple. Simple Not only does it have to be signed, if possible, but it has to be witnessed or you can get a notary. So let me go over that again the document should be signed and witnessed by two people, or the document can be notarized and that serves in the place of having the two witnesses to validate the document as legal. So the whole issue here is, the state wants to make sure that the patient is competent and is not being coerced in terms of signing this document.
Speaker 2:But even if it only has to do with medical conditions, of medical services, they want to make sure that the patient is competent and the patient is not being coerced, and one of the ways the state of California at least, does that is that if the patient chooses to have two witnesses, this is a list of individuals who cannot be one of those witnesses. It cannot be a health agent. A witness cannot be a health care provider. A witness cannot be an employee of a health care provider. A witness cannot be an operator of a community care facility. A witness to an advanced directive cannot be an employee of a community care facility. A witness to an advanced directive cannot be an operator of a residential care facility for the elderly, and a witness to an advanced directive cannot be an employee of a residential care facility for the elderly.
Speaker 2:So what's the point here? The point is that whoever witnesses a patient's advance directive must be what we call a disinterested party that's sort of a legal term but it must be someone who cannot benefit in any way from the decision that the patient has made pro-ACON or one way or another. In terms of signing this document, it must be a disinterested party. Now, one of the two witnesses must not be related and this is in California must not be related to the patient by blood, marriage or adoption. It must not be entitled to any part of the patient's estate by operation of law or under the patient's will, because, remember, here you can expand that beyond the medical treatment to include your assets and your will, and et cetera, et cetera. So, again, the witnesses must be basically disinterested parties.
Speaker 2:Now, the alternative to validation of the advance directive document, the alternative to having two witnesses, is to have the document notarized, to have the document notarized, and the way to do that is you call in a notarite, he or she will come in, they are licensed individuals by the state of California and I'm sure you have notaries in your state also and they basically have a process that they go through where they ask certain questions, they have individuals to sign I have the patient to sign certain things and they have ways of showing that the patient is competent. And by doing that they then put the seal, they put the notary seal to the document and it then becomes a legal document. So notary is one of those things that's very important. And you might say, well, find a word. When I use a notary, why don't I just get an attorney? Well, you can certainly get an attorney, and let me just say this you can have an attorney to set up your advanced directives, but in my opinion, you don't need to have an attorney to set up your advanced directives.
Speaker 2:Many individuals are hesitant about getting attorneys because they're worried about the cost, and rightfully so, and I can certainly understand that. So if that is a concern, it is not a requirement. Again, doctors, offices and hospitals can assist you with the processes that we've outlined so far without the need for you to go out and hire your own attorney. You can if you choose, but you don't have to is the point I'm trying to make. One of the things that the notary will do is that they will identify who you say you are, and they do that with basic things like a driver's license or something very similar. And then the second part of what the notary does is that they have to evaluate your competency. And I'll give an example If the patient say is comatose, where the patient cannot speak and cannot communicate yes, no to an individual, the notary cannot do their work.
Speaker 2:In other words, the notary does not work under those circumstances because the patient must be competent to be able to communicate, and so in that situation the notary would not be an option. So basically, what I'm saying is do this ahead of time. Do not wait until individuals are very, very ill in the hospital and there's worry or concern about what may or may not happen. Doing a routine visit to the doctor and most older patients are going to have a lot of doctor appointments Doing one of those doctor appointments say I would like to have an advanced directive. Or if you go with them, you say it for them, obviously after you've had that conversation with them. Or the patient may say I want to start that conversation now. They may not want to decide right then, but at least you can start the conversation, or the patient can start the conversation with their doctor, in addition with their family. So do that ahead of time. And then if there's anything I want you to take away from this discussion is do it ahead of time.
Speaker 2:Now there are other types of directions or orders that patients can give, certainly in the state of California, and this could be for people who are outside of the hospital. Let's say you have a particular chronic condition where you may lose consciousness. The paramedic is called, you're brought to the hospital, taken care of and go back home. There. We have in the state of California something called the POST P-O-L-S-T and that stands for physician and paramedic orders for life-sustaining treatment. There are some people who, depending on their age and their age are not going to be able to take care of them, depending on the medical condition, do not want certain things done to them outside of the hospital and at least in the state of California, they can again assign that document ahead of time and that document can be presented to paramedics and others who may come to their home. This is primarily for outpatient services.
Speaker 2:Most of our discussion today is about the advanced directives, which is directed to hospital services. Other types of things that occur in hospitals that can be a part of the advanced directive is DNR or do not resuscitate, and some of you may have heard of that. This may be. There are some patients who come into the hospital and, depending on how severe their condition has been, but may have required resuscitation more than one time and some of them may have decided that they just don't want that done anymore. This can clearly be part of an advanced directive Again, directions given in advance of patients being severely ill in a hospital. Now, do not resuscitate does not mean do not treat. Do not resuscitate only means do cardiac resuscitation if I'm in the hospital should my heart stop. So there's a difference between that and it's important not to get those two confused. So one of the things to keep in mind is that with the advanced directives, the purpose is to put the patient in charge. That's the purpose and that's why you want to do it sooner rather than later.
Speaker 2:As you get the family together, or as you sit down with your elders in the family have that conversation, or with the next doctor's appointment, let's say, you take mom or dad or one of the members of your family to that doctor's appointment, ask them why don't we bring this up with the doctor and get their input about how can we go about this? But all I'm saying is start the conversation. Admittedly it's a challenging conversation, admittedly it's a difficult conversation, but I can guarantee you, in my 75 years of life and my 50 plus years of medical practice, I have seen far too many episodes of distress and pain and agony for patients and families, specifically because there were no instructions ahead of time. So I would implore you to seriously think about having that challenge and discussion with your loved ones and setting up an advanced directive, again in advance. When you go to your regular doctor's visit with mom or dad, have that conversation with your family physician or any physician, or when you go to the hospital, have that conversation and most hospitals, as I said, are required by law to ask you if you have an advanced directive, if you've been admitted for some reason, and to assist you in developing one. But don't wait until then. Do it ahead of time and I can assure you you would be happy that you're doing this.
Speaker 2:I believe very strongly, as I said, with the opening beliefs, that care is about making a contribution to others. We're all caregivers for the elderly. We're all caregivers and they don't have to be our family members or our mothers or our grandparents or aunts or uncles. They're human beings. They may be individuals we see in the grocery store or at a bus stop or in church or wherever, but just remember, we're all caregivers. But certainly this is something that you can do within your family and with loved ones to assist them and those around them on this road. So, in summary, we've had a discussion about some things to do that involve end of life issues and indeed advanced directives is in general.
Speaker 2:One of those end of life issues Is primary design for individuals with chronic illnesses and or who elderly. It is basically defined as given directions in advance about incapacitating illnesses. In other words, do you want to be connected to a ventilator? Should you be get to the point where you're unable to breathe by on your own, yes or no? Those are some of the types of questions that individuals can make decisions about, should they choose to. But as a part of this process, you can also appoint what we call an agent. So the patient may say well, you know, I don't understand all that stuff, but my son, my second son or oldest son or daughter will be my agent. I trust them to make all of those decisions for me. That is clearly okay, and so that is clearly an option that individuals can put in the advanced directive. So-and-so is my agent and he or she can make all these decisions for me. And it does not have to be a family member. The patient can decide if they're competent, and they would be competent if they're doing an advanced directive, who that agent is, but someone who can represent the wishes of the patient is what's important. Again, you can certainly have an attorney to do this and to all my attorney friends but you don't have to have an attorney to do this. Many times the doctor's office or the hospital itself can help you with this process.
Speaker 2:And in conclusion, as always, I like to say my basic principles. I believe God is in charge. I know God is in charge of my life and indeed my life has been blessed to this stage because of that. Number two I have no bad days. I used to have bad days, but about 20, 30 years ago I figured out days were good or bad if I said they were. So I decided that I would have no more bad days. Most what the small stuff. Most stuff is small. Third principle and what I've learned is that when I experience a situation that I perceive as negative, that most of times it's never as bad as I think it is, and I've learned to move on from that.
Speaker 2:Principle number four forgiveness is therapy. Again, what I have learned that when someone does something in my perception to me or creates a situation that is negative to me, I forgive them immediately. That is my goal. I work very hard at them, not always 100%, but I work very hard at them Because what I have learned is that forgiveness is therapy and many times it doesn't matter who's right or wrong and all that sort of stuff Just forgive, just forgive and let it go.
Speaker 2:And the fourth, the fifth principle is that everything is a relationship in life and relationships are based on three things mutual respect, mutual trust, good communication. If you have those three things, you have a good relationship. If you do not have those three things, you have work to do. If you like these podcasts and would like to hear more we have done over 30 of them this year I would encourage you to subscribe to the Health and Wealth and Wealth Podcast. You can go to wwwbusroutcom forward slash 210103. That's wwwbusroutcom forward slash 210103. And finally, be the change that you want to see in the world. Thank you and have a terrific day.
Speaker 1:Thank you for listening to this episode of the Healthy, wealthy and Wise Podcast with Dr William T Choctaw, mdjd. Be sure to check out other great episodes covering areas of health, wealth and wisdom at wwwbusroutcom and, while you're there, be sure to check out the books, blogs and other literature in your preferred format, and don't forget to leave a review, subscribe, share and support the podcast that's at THWPcom. You've been listening to the Healthy, wealthy and Wise Podcast with Dr William T Choctaw, mdjd.
