Viewpoint - Ask if patients have living wills

Use summary care records to avoid overlooking end-of-life care wishes, says Dr Pablo Millares Martin.

Dr Pablo Millares Martin: 'We live in a world where primary and secondary care can share basic information quickly and reliably through SCRs' (Photograph: UNP)
Dr Pablo Millares Martin: 'We live in a world where primary and secondary care can share basic information quickly and reliably through SCRs' (Photograph: UNP)

I was surprised to read that living wills are very popular in the US. According to a 2007 survey, 40 per cent of adult Americans had completed one.

I decided to check what percentage of our practice population had one and could only find a few - roughly one patient per thousand - of whom only two patients had given us a copy of the actual will.

This led me to wonder whether in the UK making a living will has yet to catch on in a big way - although I am in no doubt that people are increasingly making them.

End-of-life wishes
Another explanation might be that patients are failing to inform their GPs about their end-of-life care wishes.

Presumably they tell their relatives and solicitors, asking them to inform the clinicians concerned if they become so ill that decisions about prolonging life or not need to be taken.

Also, perhaps with patients who do give their GP their living will, the existence of the document may get logged in the patient record, but in a place where it is likely to get missed.

Indeed, I have to wonder whether in the past there was ever any point in putting a note that the patient has specific end-of-life care wishes in traditional 'Lloyd George' record envelopes.

Things have changed considerably over the past decade or so and computer records have made it possible to dig out living will information easily.

But as with paper records, terminally ill patients' wishes may still get overlooked, particularly if they are unable to communicate, unless the details are available to all care providers and easy to access.

Over the past couple of years, clinical software has evolved considerably and we share our clinical records with our out-of-hours provider, making an entry of a living will more likely to be spotted.

But hospitals are the places where most decisions to prolong life or not are taken. We now live in a world where primary and secondary care can share basic information electronically, quickly and reliably through summary care records (SCRs).

My practice contacted the patients with living wills to ask them if we could use the SCR to record this fact. Most replied, sending us a copy or telling us which relatives to contact.

The SCRs for these patients have been modified to indicate that there is a living will held by the practice or with names, addresses and phone numbers of people with a copy of it.

At last it makes sense for patients to tell their GPs if they have a living will and for us to ask them.

  • Dr Pablo Millares Martin, a GP in Leeds

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