Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and award winning veteran broadcaster Ron Aram will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Rajay Seudath.

RON AARON
Welcome everybody to the award winning Docs in a Pod. I'm Ron Aaron. Delighted to have you with us. We're talking in just a couple of moments about a really important topic that all of us, really, no matter your age, ought to think about. That's advance care planning. WeÕll explain it and why it's important. Meanwhile, let me welcome our co-host. Dr. Rajay Seudath. Dr. Seudath is board certified in family medicine. He's a Tampa native and the current lead physician for Optum. He's at the university location in Tampa. Dr. Seudath received his medical degree from the University of South Florida Masonic College of Medicine. He has a passion for primary care in guiding his patients to meet their health care goals. Dr. Seudath, as always, great to have you with us.

DR. RAJAY SEUDATH
So happy to be here. Thank you for bringing me.

RON AARON
Now, I know one of the goals for every primary care physician is to get their patient to, in writing, put down an advance care plan.

DR. RAJAY SEUDATH
Absolutely. It's one of the things that some people say, you know, doctors can only go so far. Where science stops, God takes over. It's a well-known saying, but it's true in some regards that we all will pass from this life. This is a journey, and it will continue, and that's just another part of that journey. Making sure our patients understand that that's something we need to talk about. That's part of that journey. And we can help them. We can support them even up to that point. It takes some of the terror away from our mortality.

RON AARON
We're going to welcome our guest who's going to talk about advanced care planning. Heather Veeder is the regional medical director with VITAS Health Care in the Midwest Division, including Texas. She earned her medical degree and completed her residency at Wright State University in Dayton, Ohio, and completed her fellowship in hospice and palliative medicine at UT Health Science Center in San Antonio. Dr. Veeder is board certified in family medicine and hospice and palliative medicine. She is passionate about working in hospice. Her purpose as a physician is to prevent and alleviate suffering for those near the end of life. Dr. Veeder, thanks so much for being with us and the award winning Docs in a Pod.

DR. HEATHER VEEDER
Thank you for having me.

RON AARON
Let's go back to the beginning when young Dr. Veeder was finishing up med school. What led you into this specialty looking at palliative care and hospice?

DR. HEATHER VEEDER
I went to medical school late. I graduated med school when my daughter graduated high school. My plan was as soon as I was done with residency, go directly into primary care. I'm a family medicine doctor, and I do miss that. I do miss that sometimes, but also, once I discovered hospice, it's one of those things where I had to be. I know as myself I need to be needed, and people who are nearing the end of life usually need someone to help them along on that along the last journey. I think so many people near the end of their lives get missed, they get forgotten, and I want to make sure that doesn't happen for as many people as possible.

RON AARON
That's beautiful. For those who don't know the difference and importance of palliative care versus hospice.

DR. HEATHER VEEDER
The catchy phrase, even though I don't think anything in hospice and palliative is really catchy, would be that all hospice is palliative care, but not all palliative care is hospice. So, when we're talking about hospice, this means that we think that a person is near the end of life. This is where we are evaluating someone, and we're saying that we think that they have about six months or less left in their life. Now, we don't have a crystal ball, so we can't say that is exactly right. But then palliative care, I know I'm biased, but I also think palliative care should be throughout the entire medical continuum. When I say, as a doctor, I want to prevent and alleviate symptoms, it's not just physical symptoms. Palliative care, we are working to prevent and alleviate anything that would be painful or harmful to somebody. So, when someone first gets diagnosed with anything that might become life threatening, the idea of validating anything that might be detrimental to somebody that we can is a good thing. I think if more people had that approach in general, it would help the quality of life for a lot of people.

RON AARON
I like that. We're going to come right back to you and Dr. Seudath in just a moment. I'm Ron Aaron. You're listening to the award winning Docs in a Pod. We come to you every week on podcast, available wherever you get your podcast. We're also on the radio in a number of markets in Texas and Florida as well. Dr. Rajay Seudath, our co-host is here along with Dr. Heather Veeder, and we're talking about advanced planning and hospice and palliative care. Give us the 411, Dr. Veeder. When I say advanced planning, what should people hear and think?

DR. HEATHER VEEDER
Advance care planning is really helping people determine again, at any point in their, in their life what are the things that they would want to happen if they couldn't make decisions for themselves? What are the medical treatments that you would want or what's acceptable as far as quality of life? What are the treatments that you don't want or what's the quality of life that isn't acceptable? And it changes, but it you don't have to be terminally ill to benefit from a document like that. It's a conversation. It's an ongoing conversation. The document is what we need because we're in America and we need something to document it to make it valid.

DR. RAJAY SEUDATH
Building on what Dr. Veeder was saying, I definitely think advance directives are really important. I think because it allows your health care provider to go over what does everything mean on those documents? When you're going over an advanced directive, that's not a two-minute talk. That's a talk you want to make sure people are understanding what they're signing. I feel that sometimes as doctors we fall into the used car salesman routine where you say let's just get this thing signed and then we'll talk about it later. No, really. Truly, we want you to know exactly what you're signing. We want you to know what this means. This is how I say it to patients. Whether you want to be on life support and have all of these interventions or whether you don't want to have them, once you're on the slab, no one can know what you're thinking. An advance directive is your will of what you want to happen at that time. We can't know what that will is unless you tell us. It's called the living well. What exactly do you want us to do? If we don't know from you, from your words, we're going to do what we think is right for you. So, your daughter versus your son versus your wife, they may know a version of you and think, this is what you want, and this person may think this is what you want. That's when we can get into clashes. Doing IQ work, when we have people who don't have advanced directives and they're in this situation, we get into situations where families are almost torn apart because it goes like this. Dad was sick. He was in that room. Every day we would walk in there he was moaning. He was in such pain, and you kept in there for two weeks until he died. Or the other person says, dad was in that room, and I could feel him with my hands, and he was warm. I knew there was a spark of life in him, and you murdered him. That's a horrible thing for a family to have to go through when simply that person could have told us, this is where I am, this is what I feel. Or even if they don't know what they want, they could have that conversation with their family.

RON AARON
Dr. Veeder, you said something very important. It needs to be in writing because when your husband, your dad, your mom is in that ICU room, it's not good enough for you to say, well, look, they told me he didn't want any extraordinary steps taken. Unplug him. Let him go.

DR. HEATHER VEEDER
Right. One of my questions is what does extraordinary mean? It means a different thing. Everything means different things to different people. For better or for worse, it's really hard for medical professionals to make a decision without something written like that, especially if somebody is at home. I mean, even outside of the hospital, if somebody is at home and they collapse without an out of hospital DNR, which is different from the one that's in hospital. If someone calls 911, EMS has to perform CPR. They have to take that person to the hospital. Even if that person said a million times, I don't want that, unless they have that paper, that's what they're obligated to do.

RON AARON
That's a really good point because if you don't have that paper handy, if it's not excessive, they won't know what to do, whether it's EMS for the ER or the ICU doctor. So, that brings up another question, and we'll come to that in just a moment. Where do you keep those documents and how do you make them accessible? Because you can have everything written down, and I'll give you an example in a couple of moments of a guy who did, but nobody paid attention. You're listening to the award winning Docs in a Pod. I'm Ron Aaron, along with Dr. Rajay Seudath, who is our co-host, and our special guest, Dr. Heather Veeder. Thanks for joining us today on Docs in a Pod.

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RONA ARON
We're so pleased you're sticking with us right here on the award winning Docs in a Pod, our podcast is available wherever you get your podcasts. We're also on the radio in several markets in Texas and Florida as well. I'm Ron Aaron, along with our co-host, Dr. Rajay Seudath, and we're talking with Dr. Heather Veeder. Dr. Veeder is the regional medical director of the VITAS Health Care in the Midwest Division, which includes Texas and surrounding states. We're talking about advanced care planning. I raised the question, where should the document be? And I'll give you an example of why that can be an issue. Years ago, my wife was working with a guy who literally dropped dead in the office. He was resuscitated. EMS came. They resuscitated him multiple times on his way to the hospital. They get him to the hospital, and they're caring for him there. They reached out to his daughter who said, well, wait a minute, he had a DNR. They're not supposed to do all that stuff. Nobody knew about it. Nobody had it. So, they actually asked me to go to his house to see if I could find it. I rummaged through his desk. I looked around, nothing. Nada. End of story. After he comes back and he's finally recovering, you know what he said? Boy, I'm glad they never found that DNR. So, that's a mixed story, right? Dr. Veeder, where do you keep those papers?

DR. HEATHER VEEDER
Well, if you don't know that you actually want it, wherever he had it, it was fine. But if you really, truly want that followed, I would say it's the exception that someone who is still going to work, has an out of hospital DNR. I think that is an exception. I'm dealing with a small subset of people who are usually not leaving their house anymore because they're so sick. So, we encourage people to put it in a prominent place in the home. Whether itÕs next to the front door, whether it's on the refrigerator. On one of your recent podcasts, they recommended putting it in a bag in the freezer, but I can tell you until listening to that, I never would have thought to look in the freezer. Somewhere prominent, right? I feel like it's so hard to know, okay, well, where do you keep this? But you put it somewhere, and then you tell everyone that who is making decision, you tell them where it is.

RON AARON
Now, will EMS take the time to look around to find it before they resuscitate you?

DR. RAJAY SEUDATH
Here in Florida, they will definitely look on the fridge. So, I tell every person who has a DNR, I want that on your fridge with a magnet. Multiple magnets. I don't want it falling down and going under your fridge. In Florida, when you sign a DNR, it has to be on a yellow slip of paper. It can't be a white paper. It has to be yellow. There's a top part, and then there's a bottom part for your wallet. So, I snip off the bottom part, I laminate it in office, and I say this goes in your wallet. So, there's one in their wallet on their person, and there is one on the fridge. Everybody involved should know this is where grandpa's DNR is.

RON AARON
Interesting.

DR. HEATHER VEEDER
Yeah. That's a great point because in Texas we don't have a wallet-size card. I think in. West Virginia, they have an electronic database that people can go to. Or you can pull it up on your phone and say, here's my document. So, that is an important thing is depending on what state you're in what may decide what you have available.

RON AARON
Will a copy be at your PCPÕs office?

DR. HEATHER VEEDER
Very much should be, and frankly at your pulmonologist office and your cardiologist office.

RON AARON
All of your ologies.

DR. RAJAY SEUDATH
Building on what you just said, Ron, oftentimes when I ask patients about their advanced directives say, oh, there's one at my lawyer's office. Well, at 8:00 on a Friday night, your lawyer's office is not open. Your doctor's office, if you call the on-call service, they're going to have access to that. They'll be able to pull it up on the electronic health record, even the on-call guy. They can tell the hospital, and they can tell whoever is calling in, this is what this patient has, and they can get that to them. So, it is important for your primary care office to have a copy. Absolutely.

RON AARON
So, Dr. Veeder, what are the options that you might have in completing your advanced care directive? Everything from the kind of care you want, the kind of intervention you want, what's included?

DR. HEATHER VEEDER
It depends on what form you're completing. Some forms are legal documents. Some forms are medical documents. For example, the pulse, and there are other versions, those are physician's orders. But not specific to physicians, nurse practitioner, PA, but those are orders. So, if you don't want certain interventions or you want limited interventions, that is something that even if I can't make decisions, this is a preexisting order for that treatment team to follow. So, that's an order, right? Not valid in all states. We're trying to get these in place in Texas. But then, there are legal documents, such as a medical power of attorney. That is a separate thing. So, it's much more convoluted than it should be. But I would say having a medical power of attorney is very important because sometimes those closest to you can't make the decision that you would want them to make, frankly, because they love you too much. They don't want to lose you. But if you've said, hey, I don't want this, I'm having someone who's able to take a pause and say, no, this is this is what she wanted, that's who may be the person I want to be the decision maker if I canÕt make my decisions.

RON AARON
Let's come back to that for a moment because someone once said to me, you do not want the people closest to you to have that authority under a medical power of attorney for the reasons you just said, Heather. They may not want to honor your requests. They don't want to let you go. They don't want you to suffer, but they don't want you to die.

DR. HEATHER VEEDER
Right. It's not a question of selfishness. It's a question of loving somebody. It may be someone close to you. I think the people that I love, I think I can make those decisions but I'm also working in end-of-life care.

RON AARON
ThatÕs your field.

DR. HEATHER VEEDER
Yeah.

DR. RAJAY SEUDATH
I think another important piece is talking to the people who you are going to elect to make those decisions. I had one guy who wrote Barack Obama as the person he wants to make his health care decisions in that situation. I was like, I don't think we're going to be able to contact the president, when he was president at the time, I don't think we're going to be able to contact him to get his input on your advance directive if you're in a state where you're not getting better. Talk to the person. On our forms, there's only two spots. There's a primary and an alternate. He says, well, Doc, I've got five children. If I pick two, three are going to give you mad at me. So I said, well, you can talk to all five of them. Anybody who has a stake in what's going to happen to you, anybody who would want to have a say, let them have a say and go around the circle and say, if I'm in a situation where I am not getting better, there is no hope for me to survive, what would you want to do for me? And he did that. He went around the circle. Whatever you want, dad. Whatever you want, dad, whatever you want. No, we've got to pull the plug. I got to get that insurance money. That was his oldest son. He made a joke of saying that, but he wanted all of the full measures. He wanted to be full of code. So, he said, actually, I was going to make him take my health care surrogate, but after hearing what he said, I kind of don't want him to be my health care surrogate. Having that information and talking about it is important for knowing who should make that decision.

RON AARON
Now, is that conversation that ought to be facilitated because not everybody on their own can get that conversation going.

DR. HEATHER VEEDER
Yeah. We as health care providers can help facilitate that. I've done many times where people are remoting in on phones where we're doing them, in person, sometimes we have to do it as an emergency in the ICU. This is where we think things are going. We really need to have everybody's input. I think even if it's just letting them voice their opinion, whether they say, I'm not going to say yes or no for, you know, putting them on comfort measures, but I just want to let them know I feel this way about it. But I'm not voting. I'm abstaining from voting., and then everybody gets their say. And I think that's important because the last thing you want is the people who survive this person who is in this situation to now all of a sudden, they're not able to be with each other. They're not able to enjoy themselves as a family. That's heartbreaking.

RON AARON
So, Heather, we got about two minutes before we go. What are some of the other documents that you need to put together for advanced care planning?

DR. HEATHER VEEDER
It's knowing what somebody wants. There are a number of different brands of care planning out there. I think that the pulse is especially important because it's orders to your treatment team. Then that living will or whatever you have that is specifically spelling out what you would like. I do think having that medical power of attorney is so important because it can help prevent a family from fragmenting. It can help people say, I don't need to make this decision. Dad's already made it. I'm just making sure that what happens is what he wanted. So, those are truly, I think, the most important.

RON AARON
Before we let you go, the work you're in seems so rewarding to you. What's the psychic income you get?

DR. HEATHER VEEDER
Oh, wow. I've never been asked that question before. Oh, my goodness. I don't even know how to answer that. It sounds so corny, but I talked about this the other day at work. I get to do good for people. What I'm doing, I think is a good and important thing. People make their own decisions. I get to help them. Either way, I get to support them in what their decisions are.

RON AARON
That's perfect. Thank you. Appreciate it. Heather Veeder, thanks so much for being with us. Regional medical director with VITAS Health Care and Dr. Rajay Seudath, we always have a great time. Thank you Dr. Seudath. I'm Ron Aaron. We'll talk with you again soon right here on the award winning Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen. Next week, two Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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