20 Improvements in End of Life Care Changes Internists Could Do Next Week! Don Berwick, MD Institute for HealthCare Improvement at the ACP-ASIM Annual Meeting, April 22, 1999 (prepared by Americans for Better Care of the Dying) 1.Ask yourself as you see patients, "Would I be surprised if this patient died in the next few months?" For those "sick enough to die," prioritize the patient's concerns - often symptom relief, family support, continuity, advance planning, or spirituality. 2.To eliminate anxiety and fear, chronically ill patients must understand what is likely to happen. When you see a patient who is "sick enough to die" - tell the patient, and start counseling and planning around that possibility. 3.To understand your patients, ask (1) "What do you hope for, as you live with this condition," (2) "What do you fear?," (3) It is usually hard to know when death is close. If you were to die soon, what would be left undone in your