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How Advance Medical Directives Became a Way of Life in One American Town

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With just over 50,000 residents, La Crosse is a lot like other small American towns – but there is one thing that makes La Crosse stand out: 96% of La Crosse residents who have died have had an advance medical directive in place. Nationally, the percentage of Americans with an advance directive stands at about 30%.

Actually, there are two things that make La Crosse stand out: the town also has lower healthcare costs than any other place in the U.S. And these two things – a high incidence of residents with advance directives and low healthcare costs — are inextricably linked.

According to a recent NPR story, all this came about because of one man: Dr. Bud Hammes, Medical Humanities Director at Gundersen Hospital in La Crosse. Dr.Hammes often found himself sitting with families of terminally ill patients, trying to figure out what to do next. He said the conversations were excruciating: “Did mom ever say anything to you?” “Do you know what dad wants?” He said that the moral distress of the families was tangible.

Dr. Hammes knew that this could be avoided, since most patients were usually sick for years. So he started training nurses to ask patients if they wanted to sign an advance directive and over the years planning for death has become a way of life in La Crosse.

And the lower healthcare costs? Dr. Hammes said that the reduction in spending was an accident, a byproduct of letting people make their own choices. He said that when you let patients choose and direct their care, they often make a much less expensive choice.

You can listen to the entire NPR story here:

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