When I was an intern in the ICU, it struck me how many families were unprepared to make medical decisions for loved ones who could no longer make their own. Only 36% of Americans have an advance directive, which means the majority of families make medical decisions without much guidance. The families of patients who had an advance directive were in a much better position to make decisions confidently. Not only that, but their emotional burden was reduced during this time of crisis.
Even when patients had an advance directive, most were created with an estate attorney. While these documents could be helpful, I found they often were challenging to implement in a clinical setting. They were often too broad or did not seem applicable to the situation. I felt strongly that these conversations should be physician-led.
Once in practice, I started teaching courses to seniors in the community on how to create an advance directive from start to finish. I start at a high level, covering what an advance directive is and how to choose a medical power of attorney. I also cover the advance directive forms, differentiating them from MOLST forms. I specifically found confusion between advance directives and Do Not Resuscitate orders, so I now clearly teach about that distinction. I created my online course to enhance accessibility.
I have now taught hundreds of students, including estate attorneys at the Montgomery County Bar Association of Estate Attorneys, my fellow Family Physicians as a conference speaker, Family Medicine Residents at Georgetown University Grand Rounds, as a guest on various podcasts, and even on the local DC Fox 5 Morning news for National Healthcare Decisions Day 2026.
View Dr. Tanno's Advanced Directive Website
In 2025, the County Executive appointed me to join the Montgomery County Commission on Aging. I was also appointed to the Board of Directors of the Maryland Academy of Family Physicians in 2025 and am on the Advisory Board for The Washington Home, a charitable foundation that provides funds to support seniors in Washington, D.C.
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