SAN ANTONIO -- Little did Jerald Winakur realize, photographed as a boy standing behind his father Leonard, that as a specialist in geriatric medicine, he would write an essay asking, “What Are We Going To Do About Dad?”

“If I am having a difficult time, if my family is having a difficult time, I could barely imagine what other families were going through,” said the clinical professor of medicine at the University of Texas Health Science Center of San Antonio.

First published in Health Affairs, his essay generated thousands of e-mails, especially after it was printed in the Washington Post and other national newspapers. Calling it an awakening, Winakur said he decided to respond to all those patients and families who read his essay, then told him of their suffering and doubts, by writing a book after the death of his 86-year-old father from Alzheimer’s disease.

Besides including questions they can ask or places where to seek advice, Winakur said the take-away from his book is simply, “These conversations need to start early among family members.”

Yet counseling about end-of-life treatment and care and advanced directives to survivors, such as do not resuscitate orders, took on a totally different meaning in the fury over health care reform.

“This was described as, you know, some sort of plot to, ‘Pull the plug on grandma,” said Winakur about that phrase thrown out at raucous town hall meetings, along with “death panels.”

“I think that was unfortunate hyperbole,” said Winakur.

As a result, he said he’s afraid Congress is considering pulling the plug on a proposal to pay physicians, like him, for the time spent counseling patients and families in distress about tough decisions that should not be rushed.

“It’s a shame, of course, for the main reason is that this is when families need this type of help,” he said.

Still, Winakur said he will be watching and listening on Wednesday to President Barack Obama’s address to a joint session of Congress.

“We’ve got to pay physicians, develop a system that rewards physicians for what’s in here,” he said as he pointed to his head, not just medical procedures and testing.