Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

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Whether you are healthy or have a chronic or serious illness, there comes a time when decisions about medical treatment, finances, end-of-life care, and funeral wishes need to be discussed. It is important to discuss your ideas, concerns, and wishes with a trusted loved one and also to document your wishes by using the appropriate forms in the event that you become too ill to communicate these wishes. While some documents require the help of an attorney and others do not, it is important to know about the documents and how to obtain them.   

Advance care planning is a term that refers to the types of plans someone can make about medical treatment, financial decisions, end-of-life wishes, and other choices if and when they become unable to care for or speak for themselves. A caregiver, be it a family member or paid helper, will need to know this information and may need to help with obtaining the necessary documents.

Because this type of planning for the future can be difficult to discuss with loved ones, you may have to take the fist step in bringing up the topic for discussion. Consider the experiences of your relatives and friends and whether or not they had documents in place to ensure that their wishes at end-of-life were carried out.

There are documents that can be prepared in advance that state your wishes for end-of–life care and select someone to speak for you if you can longer speak for yourself. Keep in mind that a person must be mentally competent to give decision-making authority to someone else. A person with Alzheimer’s disease or another illness that affects decision making and the ability to think clearly must complete documents while they are still competent to do so.

Remember that medical conditions, living situations, and preferences change over time. Take into account that even the closest relatives may not agree with your wishes. Select someone who can truly speak for you even if they would make different choices for their own care. Review your documents from time to time and make any necessary changes or updates.

Additional References:

Decisions About End-of-Life Planning

End-of-life planning really means planning ahead as much as possible for the type of care you prefer as you approach your final days of life. It is a good idea to do this type of planning in advance, while you are healthy and can make good decisions about what you would like to happen in the event of a sudden or prolonged illness. Depending upon your specific condition, this could mean decisions about:

  • How much life-sustaining treatment, like a feeding tube or breathing assistance, you would want
  • Resuscitation if your heart stops
  • Starting, changing, or stopping medications and treatments
  • Staying in your home or going to a nursing home for care

End-of-life planning includes deciding what being independent means to you and whether you would prefer to die at home or not. It also includes how much you want your care to involve family members or paid helpers. Spend some time thinking about your spiritual beliefs, your view of dying, and funeral preferences. Let your loved ones know your choices.  

There are three different types of documents that help caregivers know what your wishes are:

  • Advance health care directive
  • Physician's orders for life-sustaining treatment 
  • Power of attorney

Each of these documents should be copied and shared with your doctor, attorney, caregiver, and family/friends. Keep your documents in a location that is safe and easy to access.

Advance Health Care Directive

If you are able, it is up to you to make all of your health care decisions. However, if you are unable or unwilling to make decisions, the law allows you to choose someone else to make health care decisions on your behalf.

An advance health care directive, or AHCD, is a legal document which allows you to tell others what kind of health care you want to receive when you are too sick and unable to make decisions about your care. The AHCD form also lets you identify the person(s) you choose who will work with your doctors and others to help ensure that your wishes about your health care are carried out. This person is called your health care agent. 

You can also write down your wishes about organ donation and identify your personal care physician. Anyone who is 18 years or older can complete an AHCD. The AHCD does not expire and stays in effect until you change or revoke it. 

An advance health care directive packet is available at your local medical center. Ask for one in the Health Education, Member Services, or Social Services Department.

The AHCD packet includes:

  • Step-by-step instructions for completing the AHCD legal form
  • The AHCD legal form
  • The roles and responsibilities of the health care agent
Additional References:

Physician Orders for Life-Sustaining Treatment (POLST)

The Physician Orders for Life-Sustaining Treatment (POLST) is an important form that indicates what types of life-sustaining treatment you do or do not want if you become seriously ill. Completing a POLST is voluntary. The POLST does not replace the AHCD. The POLST is intended to help you discuss with your doctor specific plans that reflect your wishes and assure you will be treated with dignity and respect. The main areas covered by the POLST are:

  • Cardiopulmonary resuscitation (CPR) – attempt or not
  • Medical intervention –  comfort, limited, or full
  • Artificially administered nutrition – feeding tube for the short-term, long-term, or not at all

The POLST also helps doctors, other health professionals, and emergency personnel honor your wishes for life-sustaining treatment, especially in an emergency. The POLST form remains with you regardless of whether you are in the hospital, at home, or in a long-term care facility. If you live at home, keep the original POLST form where emergency responders can find it. The POLST form is signed by you (or your health care agent or conservator) and your doctor. 

The POLST was developed by the Coalition for Compassionate Care in California. The POLST form replaces the living will in California. In other states, the form used to document choices for life sustaining treatment is still called a living will.

Power of Attorney

Power of attorney is a term used to describe the legal authority you give to someone to make financial decisions and manage your affairs for you. You do not need to be ill or incapacitated in order for this person to act on your behalf. The person you choose to give the power of attorney to does not need to be a lawyer. You will, however, need the services of a lawyer to give these rights to another person. It is possible for you to appoint one person to make medical decisions for you, as in assigning a durable power of attorney for health care decisions, and select another to manage your financial and other legal affairs. Or you can select the same person to make both types of decisions. Each state has rules about what a power of attorney means.

Additional References:

Where to Get More Information on Advance Care Planning

Several Kaiser Permanente facilities offer classes on advance directives and end-of-life decision making. To check the class schedule, call your facility’s Health Education Center or explore classes on this website. You can obtain forms through the Social Service or Member Services Departments at your medical center.

If you have questions about advanced care planning, we can discuss this during your next visit or you can send me a secure e-mail message from this website.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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