Doctors at Kent Hospital in Warwick, R.I., are breaking new ground - but it's not the old guard - it's the residents, those doctors fresh out of medical school and in the throes of training, who are demanding to be taught how to interact with their patients preparing for end-of-life care.
After spending time in hospital and exam rooms with patients who had not discussed their options with family members or their doctors, many of the residents saw a need to bring the issue to the forefront.
"One thing we run into all the time is patients coming into the hospital not having this conversation, no matter what the age, and then sometimes they get into a situation where they can't speak for themselves," said Christopher Peters, a second-year internal medicine resident at Kent. "We're left asking the family what they think the patient would have wanted, and many times they don't know."
Dr. Kate Lally, the director of palliative care at Kent, introduced a program to the residents to teach them how to talk to patients about their options - at any stage of illness.
"I think when you come into medicine you come often right out of college and you're new to this and there are a lot of skills that you're going to learn," she said. "You're going to learn how to treat a heart attack, and residents need those skills. But they also see how sick some of our patients are, and they see that patients are struggling to make decisions…so I think residents are really demanding of us as people who've been in medicine for a number of years - 'teach me how to do this with my patients…because just like any of these other skills this is what I need to be a good doctor.'"
"I can't tell you how many patients I've had say, 'you're the first person who's asked me about this,'" said Amber Hines, also a second year resident. "It's pretty shocking."
Patients, according to Lally, are also becoming more comfortable with preparing for end-of-life scenarios - many times because of experiences they've had with their own loved ones.
"I think doctors and patients have noticed that the way we practiced medicine for a long time was not necessarily for the best," she said. "And honestly, I think a lot of patients have been saying to their doctors, 'let's talk about what I saw with my grandmother, I don't want that to happen to me.'"
And the doctors, practicing what they preach, are having the conversation with their own families. "Even my grandparents laughed because they were like, 'well, nobody's ever brought this up before,'" said Hines. "When it comes to that situations where something happens and a decision needs to be made, the families that have these conversations, it's so much easier for them."
The time for having the conversation, Lally says, is right now.
"None of us really knows what tomorrow is going to bring, and so I think it's important for all of us to sit down and start the process."