See Part I here.

Doctors die differently. When you think about it, that’s not surprising. We have seen a lot and that changes the way we look at things.

Importantly, doctors have a more realistic understanding of the limitations of what medicine can offer. If your primary source of information about healthcare is TV, you would expect the likelihood of surviving a cardiac arrest would be 77 percent. In reality, doctors know that your chances are not good and your chance of surviving a “code blue” is less than one in ten. Even if you survive the resuscitation, there is an excellent chance that you may never return to your former self and even more concerning; you may spend the rest of your life in a coma.

As a result, doctors are much more likely to have an advance directive than lay people. Sixty four per cent of older doctors have taken the time to complete the paperwork compared to less than 20 percent of people who are not in the healthcare profession.

I have often heard, and read, that many people believe doctors and the healthcare system push patients to have tests and procedures that they do not want or need. And, it is true that in the United States, patients have much more testing and receive many more procedures than patients anywhere else in the world. Despite this, our patients' outcomes are not as good as many other countries, even though we spend more per capita than anywhere else.

Yet, as physicians, we are routinely challenged by patients, or patients' families, who demand testing, procedures or medication that we do not believe is needed. That is a continual source of frustration for us and we try to devise ways to avoid care that is not indicated.

So whose fault is it? Is it the doctors' or the patients' fault?

The answer is that the problem is not any specific individual. The problem is a lack of communication.

This is especially true around decisions at the end of life. There are several reasons for this. Talking about dying is hard. Many of us continue to feel a sense of immortality even though our twenties occurred a very long time ago. As a society, we are not very comfortable with death. It is often seen as a sign of failure. In the past, people died at home and their families came to know what it means to die. Today, you are much more likely to die in the hospital or a nursing home. Despite this, we overwhelmingly would prefer to die at home.

So how does one go about having a chance to die at home?

The answer for me is grounded in a lesson I learned from my father.

As my dad struggled with the decision of whether to undergo chemotherapy for advanced lung cancer, he quickly realized his goal was not to pursue more days alive, but rather, to live the rest of his life meaningfully. He chose to forgo chemotherapy and identified the goals he wanted to meet before dying. He completed the design of a church he was working on. He deliberately and intimately connected with family and friends. He put his financial affairs in order. He even planned his entire visitation service and funeral, including designing the memorial card handed out at his wake.

In order to accomplish all that, he had to talk with a lot of people. Everyone important to him knew the plan. His family, his doctor, his business associates and his close friends all understood what to expect. And we all knew that my dad was living the way he always had, in a thoughtful and loving manner.

And, he spent time conversing with his God. “I don’t have a problem with dying,” he would say. “I’m just not sure I agree with the timing.”

My father was able to have the kind of death he wanted because he thought about it beforehand and took steps to insure that he died the way he had always lived.

Mark Fourre, MD, is an emergency physician and Chief Medical Officer of Lincoln County Healthcare, the parent company of LincolnHealth. He also serves on their Board of Trustees. Prior to joining Lincoln County Healthcare, Dr. Fourre was an attending faculty at Maine Medical Center where he developed the Emergency Medicine Residency Program and served as Residency Director.