About Jason Tibbels, MD

Executive Medical Director

The Need For Breakpoint Conversations

Posted on April 10, 2012 by Jason Tibbels, MD

A fairly recent article in the New York Times provides a great discussion about having the tough conversation with a terminal patient. It points to a very interesting study in Sweden where discussions about death, referred to as breakpoint conversations, are less likely to be avoided, and compares those who were well informed about their prognosis to those who were not. My favorite finding in the study was that those who had a better understanding of their prognosis were more likely to die in the place they preferred (70 percent v. 39 percent). For most of us, that is at home.

Following is an excerpt from the article. Click the link provided at the end to read the full article on why doctors must become more comfortable with breakpoint conversations. Continue reading →

Death of a Billionaire

Posted on March 27, 2012 by Jason Tibbels, MD

Death is no respecter of persons. It is simply an inevitable moment that we are all marching toward, whether we acknowledge it along the way or not. I think about that moment often. I’m not sure if that’s a function of getting a little older, or solely due to my career path; it’s probably both. Over the last five years, I have seen the dying process in hundreds of its myriad manifestations, some more admirable than others. Each and every one has etched its story into my own.

I’m asked frequently whether my job is depressing, or if I have difficulty not bringing my work home. With few exceptions, I can honestly answer an unequivocal, “No”. In fact, I don’t find caring for dying patients depressing at all. There have been more sad moments than I can count, but that number is dwarfed by the moments that I count as joy. I have learned a lot from dying patients and their families, and hopefully I have honored some of those pearls by applying them to my own life. Continue reading →

Who Is P8000?

Posted on February 21, 2012 by Jason Tibbels, MD

What is P8000? Well, I guess it could be a lot of things. Maybe it’s Audi’s newest sports car. It could be something as simple as a part number for the water filter in the refrigerator my wife keeps asking me to order. P8000 is so impersonal. It couldn’t possibly be anything of great consequence.

I’m certain most have heard of HIPAA (Health Insurance Portability and Accountability Act) which in my opinion has been a burdensome, financially inefficient, and futile attempt at protecting patients’ medical privacy, but that’s a rant for another day. One annoying result of this is that our interoffice communication regarding our patients cannot refer to anyone by name, but only by some non-identifying descriptor. You guessed it, P8000 is not some refrigerator part or other “thing.” P8000 was a person.

Continue reading →

Longer Life with Hospice

Posted on February 2, 2012 by Jason Tibbels, MD

It is still a common misconception that being admitted to hospice will shorten a person’s life. To many, being referred to hospice carries the emotional response of a death sentence and the idea that modern medicine is done with them. What if I told you that some patients live longer on hospice than they otherwise would have? Well, that’s exactly what one study strongly suggests.

An analysis of end-of-life data on 4500 adults showed that patients who received hospice care lived 29 days longer, on average, than patients who did not (J Pain Symtpom Management 2007:33:238-246). The benefit was most pronounced for congestive heart failure and cancers of the lung, pancreas, and colon. Continue reading →

A Message From Future You

Posted on January 6, 2012 by Jason Tibbels, MD

It’s universal, the desire to go back and relive, re-do, or undo some part of our life with our current wisdom and understanding. Maybe it’s just one decision. Maybe it’s a major portion of your life. What if you could have the perspective of an older self, a you who is at the end of your life and could plead with you to do things differently? There’s a mind trick I play with myself when faced with tough life decisions. I pretend that my wish of, “If I could only go back and have a do-over”, came true. Here I am, with a re-do, only I can’t have any recollection of the future, as we all know that would alter the space-time continuum. With this in mind, I wonder what the Jason of the future would want me to do now that I have this second chance! While it may be impossible to be certain, there is a way to get some idea about how someone with that perspective would face the life in front of you.

What if you worked with hundreds of people who are at the end of life and ready to share wisdom with anyone who will listen? Many will tell you that they lived life with no regrets, but when you really listen to what people are saying, very few mean it. I have heard too many to list, but I thought it would be cool to talk about a few. I borrowed these five from someone who has been asking this question for years and came up with the top answers. Bonnie Ware has worked in palliative care for years and these are the five most common pieces of advice she heard from those facing the end: