Commentaries from the experts - 'Older female unsuccessful'

Doctor: there you are Elizabeth. There’s your script for your blood pressure. Everything seems good. Now there is something I wanted to talk to you about. It was about what you might want to happen to you if you become really crook and you die.

 

Patient: is there something wrong with me?

Doctor: not now. You’re fine now. I mean.

Commentary (Bill): It’s great the way he already starts off badly because we can see that he looks at the computer screen, doesn’t look at her. He fiddles around, he picks up something to play with rather than showing the body language of interested in, being interested in what’s going on.

Commentary (Karen): Yes. He looks very uncomfortable and he also starts very inappropriately in the way he pretty well says to her we need to know what your going to if die, so he’s really trying to get her to act by being scared rather than getting her to act for the right reasons.

Commentary (Bill): Yes.

Commentary (Karen): so it’s really inappropriate.

Commentary (Bill): Yes.

Doctor: say you got something really bad with you, would you want to have all that stuff done to you?

Patient: I don’t know why you wouldn’t want me to have any treatment. I want every treatment that’s available.

Doctor: No, no, no. This is if you are really crook. Probably time to plan for what could happen to you if things went wrong.

Patient: But I have got a plan. I’ve done my will, and I’ve done…

Doctor: No, no. I don’t mean financial. I don’t mean plans like that. I mean planning for what you want to do medically like if you get something really bad, not, not the sort of financial stuff.

Patient: so you think….

Commentary (Bill): he’s immediately getting annoyed with her and inpatient and frustrated the way she’s responding, and really saying things that are inappropriate.

Commentary (Karen): Yes. I mean he keeps using the word ‘stuff’ which I’m not quite sure what it’s meant to mean and I’m not sure that he’s quite sure what he’s trying to find out either. Clearly this gets the patient disengaged and she doesn’t have a clue what he’s trying to talk about. Clearly she doesn’t understand by some of her responses.

Commentary (Bill): Yes.

Patient:  so you think really bad is going to happen to me?

Doctor: no, no, no. You haven’t got..No I’m not being clear. I want you to plan for the future so that if you had a bad illness you could..

Commentary (Bill): He says he’s not being clear which is really code for your not listening and he keeps riding around in the chair which is maybe an indication that he is felling uncomfortable about the discussion. He almost wants to hurry it up and get it over and done with.

Commentary (Karen): Yes. The patient has become really disengaged and he’s obviously become quite concerned of what he’s saying and wondering what he’s really implying. He looks really concerned.

Doctor: you know. You’ve got to realise that in Australia, people spend 50% of their health budget on the last six months of their lives and most of the treatment is useless.

Commentary (Karen): It’s really inappropriate here when he refers to the 50 per cent of the health budget. It’s inappropriate to talk to patients in that way. It’s actually not the point at all of advance care planning.

Doctor: ….budget on the last six months of their lives and most of the treatment is useless.

Patient: I don’t want you to say that treatment is useless because it may help me.

Doctor: no, no. I’m not trying to say that treatment is useless all the time, but the last bit of your life its pretty, it’s a waste of time really.

Patient: (deep breath)

Commentary (Bill): (laughing). It’s hard to really know where to start isn’t it?

Commentary (Karen): Its. Look clearly there are some inappropriate things he said to this lady including talking about the health budget and you know, spending it on people in the last part of their life. It really is inappropriate and it’s actually not the point of advance care planning and shouldn’t be used to try and get people involved.

Commentary (Bill): No, and to talk about her treatment or intimating that any treatment she might get is a waste of time or useless is clearly disengaging her and she’s become less and less interested in continuing the conversation.

Patient: Well. I think I’ll just as soon leave it at that thank you very much.

Doctor: they’re asking us to fill out all these forms for you and give you all this stuff to do. You’ll be fine. It’s not.. your health’s good. You’rd on a lot of medication but you in good nick. You’ll be fine.

Patient: I don’t want to talk about this anymore. I do want treatment and I feel very uncomfortable.

Doctor: No. I’m sorry. I’m sorry I brought this up. I’m, we won’t talk about this again.

Commentary (Bill): It’s great the way he tried to hold on to her at the end and by holding on to the prescription, but he’s completely upset her and she’s obviously left and not planning to come back.

Commentary (Karen): No, and I think he ran the conversation badly right the way through and he’s probably scared her off.

Commentary (Bill): Yes.

Commentary (Karen): Lost an opportunity.

Commentary (Bill): Yes. It’s a missed opportunity isn’t it?

Commentary (Karen): Yes. So.

Commentary (Bill): Not only has he missed the opportunity now, but he’s set it up so that she’s not going be interested in talking to anyone about this sort of thing for a long time. Yes, a good demonstration of not how to do it.

Commentary (Karen): Yes.