In 2010, Doctors of BC or DoBC (Doctors of BC, the professional association of BC doctors) adopted an initiative entitled “Walk with Your Doc”. The purpose of this annual public health campaign was to promote physical health by inviting patients to walk with their physicians and talk about the benefits of daily activity.
In 2024, the Fernie MSA (Medical Staff Association) agreed to support a similar project, “Talk with Your Doc,” a local idea inspired by the DoBC initiative. Periodically, a physician will write a short article on a relevant medical issue. The hope is to create a space for healthy public engagement.
As this is a new venture, public feedback is welcome so as to best serve the needs and interests of readers.
Marian Ma, MD
Fernie
Much has changed since I first started practicing medicine in the late 1990s in the Elk Valley. Back then, Lethbridge (not Cranbrook) was our referral centre, many metastatic cancers were untreatable and health authorities did not exist. We also referred to DNR (Do Not Resuscitate), a decision made more so by physicians when treatment seemed futile. Nowadays, the responsibility for that decision lies more with each individual patient and is guided by the MOST form. So, what is a MOST form and why does it matter?
MOST stands for Medical Orders for Scope of Treatment. It is a way of communicating to health care providers (and loved ones) which medical treatments you want. Six different levels are indicated (M1, M2, M3, C0, C1, C2) with further tick boxes for other treatments like blood transfusions, dialysis, or nutritional support through your bloodstream or a tube from your nose into your stomach (nasogastric or NG tube). M stands for Medical, C for Critical; M1 (Medical 1 involves the least number of interventions and C2 (Critical 2), the most. ALL of them include compassionate treatments to keep you comfortable.
With each level another layer of medical treatments is added on: M1 is comfort care only; M2 adds in local treatments; M3 adds in transfer to bigger centres (Cranbrook, Kelowna) for tests/consults/treatments; C0 adds in transfer to ICU for monitoring and treatment, C1 adds in a breathing tube hooked up to a machine (intubation); and C2 adds in trying to start your heart after it’s stopped (CPR or defibrillation, using electricity). Or put another way:
M1 = Comfort Care (CC)
M2 = CC + Treatments in attempt to cure
M3 = CC + Treatments + Transfer to bigger centres
C0 = CC + Treatments + Transfer + ICU
C1 = CC + Treatments + Transfer + ICU + Intubation
C2 = CC + Treatments + Transfer + ICU + Intubation + CPR/defibrillation
The medical system is very good at keeping people alive, but it cannot guarantee a person’s quality of life. The MOST form is meant to guide and reflect each person’s wishes about not only quantity but also quality of life. What each person chooses is going to depend on their values, health and prognosis of their illness. As such, each person can revisit their goals of care and change their MOST level at any time as circumstances change.
From my experience, here are a few points that may help.
1. Frailty from aging and/or medical conditions make it unlikely for aggressive treatments like CPR (C2), Intubation (C1) or ICU interventions (C0) to work, causing unnecessary trauma and possibly dying while attached to machines and tubes.
2. Frailty from aging and/or medical conditions also make it unlikely for advanced medical treatments (C0-C1) to result in people returning to their normal level of function. Receiving these treatments may result in losing significant function.
3. Increased frailty often means losing one’s independence, necessitating a move to an increased care facility (Assisted Living or Long-Term Care).
4. Long-Term Care Beds are a scarce commodity. It may mean waiting months in hospital for placement. And the regional bed policy means that the bed could be located anywhere in the East Kootenays (from Creston to Golden).
5. At any point, it is okay to consider (in discussion with one’s health care provider) stopping treatments due to poor quality of life (for acute or chronic conditions). And it is certainly okay to only want M1 (comfort care only). Sometimes, treatments attempting to cure prolong suffering.
6. If you are the one designated to make medical decisions for a loved one, a helpful question is “If my loved one were totally healthy and able to see what they are going through, what would they want for themself?”
7. Medicine today is complex. Lean on your health care professionals for their expertise. Don’t try to make decisions on your own.
These discussions are hard. But better to think about it ahead of time than to be carried along in a moment of crisis and regret any unintended outcomes. Understanding your illness and what to expect is key to guiding you in these decisions. How to have these important discussions with your health care provider will be addressed in another “Talk With Your Doc.”
