Bring up hospice is like proposing to one's girlfriend

1.  It shouldn't be a surprise
2.  You should have some idea of the answer before you ask the questions
3.  It is not how you start the conversation.
4.  Don't consult social work, ask yourself!

It's interesting to me how intimidating it is for doctors/residents/med students to bring up hospice (for a variety of reasons) and for patients/families to have it brought up or to bring it up.  So to make thing simpler, I've come up with this analogy that I think applies for at least these 4 reasons.

Why it is difficult to collaborate with your physician

Recently I read two articles in the NYTimes (1, 2), stating how doctor's and patients fail to communicate or collaborate meaningfully and why that is necessary.  I recently wrote about what questions I would ask a doctor when a doctor proposes a medical intervention whether that is a surgery, a medication or a test.
Here is the problem:  doctor's don't have the answers to these questions readily available and even if they did, they don't have the time to explain the answers to those questions.

1.  Guidelines and review articles often fail to present data in a clinically relevant way.  It is up to the individual physician to go through the studies in detail to translate the info into a clinically meaningful way.  Most docs don't have access to articles or time to do things like this.

2.  It takes me a good half hour to explain the proper use of Aricept for example or the role of cholesterol medications or when to do prostate cancer screening.  It takes time.  I don't have that time.

Good intentions are nice but the data as presented currently and the structure of the office visit as constrained by financial pressures makes collaborating more of a pipe dream.