This video shows communication between older male patient and treating doctor about advance management plan options in the event of illness. The treating doctor effectively delivered the message across by listening to her patient's care needs and future health plan choices.
Doctor: okay Ian, now that we’ve reviewed all your results, I’m just wondering if it would be alright for us to talk about your future health choices if ever a situation came up where you might not be able to make those decisions for yourself.
Patient: Yes. That would be fine.
Doctor: So Ian tell me then how you are feeling about your health at the moment?
Patient: Well, I’m really not enjoying life as I used to. I, I’ve always enjoyed my golf and now I find I can’t walk around the golf course anymore, which is a worry to me. The other thing is I don’t want to be a burden to my family.
Doctor: can you tell me more what you mean about that?
Patient: I’ve been independent all my life and active all my life and I just feel I would be a burden to my family and my wife if I was laid up in bed for a lengthy period of time with no likelihood of any good outcome coming out of it.
Doctor: What do you mean by good outcome and what are the things that are really, I guess are so important to you that you wouldn’t want to lose in your life if you felt that…..
Patient: Well I think my independence is, is the main factor. I still like to be active and I certainly wouldn’t want to finish up in a nursing home. That would be the last, the worst thing that could ever happen to me. I just want to want to fall off the twig when the last putt drops in on the 18th hole at the golf course. Oh man, I would be the happiest man dead.
Doctor: So that’s, that’s, I can, I can understand what you are saying there but I guess it doesn’t always happen that way, that there’s a sudden event and we die. I mean it might be that there’s a process of illness, and a significant illness before that happened. Have you thought about what you might like done, if you were say, say if you were to have another really significant heart attack, or a stroke or something and you really couldn’t do those things that you said are so important to you?
Patient: well I have mapped it out in my mind that if I’m incapacitated to the extent where I am a liability on carers and high care situation, I don’t want to be hooked up to a whole heap of pipes and things and just kept alive for the sake of being alive. I would like to die like my grandfather died. He never went into hospital in his life. He fell of his bike at 88 and we went to visit him in the hospital on the Monday night. I said we would come out on Wednesday night and he said he won’t be here. He said he was going to his maker and he did on Wednesday morning the happiest man alive.
Doctor: Yes. It seems to me, and let me know, tell me if you think I’ve got it wrong but it seems to me that you have thought about this for quite a long time, and quite, quite deeply about it and if it was to happen that you had a very big heart attack and you weren’t able to do those things that you value highly and you weren’t independent because it comes across again that your independence is very important to you..
Patient: it is.
Doctor:.. so if you weren’t able to make those decisions for yourself, it comes across very strongly that you wouldn’t want any life or you know, heroic life saving measures..
Patient: absolutely not.
Doctor: ..yeah, and that perhaps you would like some control over these things before it happened.
Patient: I think it is better to have control now than too late.
Doctor: yeah. Since you have thought about it for such a long time have you discussed it with your family at all?
Patient: yes, I have but not to any great extent, but I have let them know my thoughts in as much as we have previously discussed.
Patient: I don’t want to be left around, lying around.
Patient: some of them are quite receptive to the idea. Others, didn’t want to know about it.
Doctor: No. There is a way you can do this. You can actually write down what you would like done. At the moment you are able to make perfectly rational decisions and you said you have thought about it for a long time, you can actually go through a process where you do write this down. Some people like to choose, perhaps, a family member after the discussion and the whole family might be involved in that discussion and decide who might be the person that’s appointed to I guess to follow through with those decision you have made because that’s what they are doing, basically they are sticking to your decisions so its something that you need to discuss very thoroughly with them and make sure they would be able to do that. It is not necessarily an easy thing in that situation.
Patient: it will save a lot of heart ache….
Patient: ..if and when something does happens..
Patient: decisions are made before hand.
Doctor: yes. Whether you decide in the end to have a family member or a friend you know following through with your wishes it’s entirely up to you and really the best fit for you and your family. People do often think that my family knows what I want and you might have been quite clear in what you want, but, but often things happen so suddenly and the situation is so distressing for people that they find themselves unable to make decisions, even simple decisions, let alone decisions that are life saving or life ending.
Patient: That’s why if there is an answer to the situation where we’re not going to have family breakups because of a fight over the deathbed for one want of a better word, we want all the decisions made and each one in the family clear in their mind exactly what’s going to happen.
Doctor: yeah right Ian. Well I’m glad we have had this opportunity to talk about this. I’ve got some literature here. This is a form that talks about the issues that we’ve discussed. It’s called advance care planning. It’s really just about decisions that you want to make for your future health.
Doctor: Take your time. Have a good read. Take you time. Discuss it with your family and make an appointment to see me after you’ve had a look, a week or two what ever suits you and we will have a talk about it when you come back next time. Okay?
Patient: Just a cursory look through there this looks like it’s the answer to my prayers. It’s going to save a lot of heart ache from all angles I think. Thank you very much for bringing this up and letting me know about it.
Doctor: You’re welcome.