Commentaries from the experts - 'Older male unsuccessful'

Doctor: right Ian, look we’ve gone through your results which you know is good and we’ve got a few minutes left so there’s something that I’ve been meaning to bring up with you. You know you hearts not that great, it’s not in good shape. You could have another heart attack any second.

Patient: oh shezz..

Doctor: so I’ve just wondered if you’ve thought about what you might do if, if that were to happen and you weren’t able to make decisions for your self, say, say you did have a big heart attack and you didn’t actually die, you would be alive and you were unconscious, have you thought about you might like....

Patient: I, I, I don’t like thinking about those sort of things because I’m not qualified to think about those sort things but I mean the way your discussing it, it’s sort of getting me a little bit up tight over it.

Commentary (Karen): I think this clearly shows this is a really bad way to have a conversation and immediately she’s got the patient disengaged.

Commentary (Bill): Yes. She’s doing a good job of bringing on that heart attack isn’t she?

Commentary (Karen): She also hasn’t given him much of an opportunity to speak. She has just kept talking, and finally he gets a chance to have something to say. He’s not very happy about it.

Doctor: Well, look well I guess it’s, it’s a fact of life isn’t it. I mean you could have a heart attack as I said at any time, so it’s something you’ve got to face up to. If, if it were to happen then, then what would you want us to do? I mean would you want us to, to stick a tube down your throat and, put you on a ventilator and keep you in intensive care.

Patient: look I, I don’t know. I’m a motor mechanic by trade and I just fix engines. I wouldn’t have a clue what you people do.

Doctor: well I mean you could think about whether you do want us to, to do your breathing for you with a machine or you know if your kidneys packed up do you want us to put you on dialysis…

Patient: isn’t that a decision that you people got to make not me?

Doctor: we can do the stuff, but we can’t necessary decide for you if you want done. Do, do you want dialysis, be fed by a tube, do you want to be intubated and on a ventilator?

Patient: I don’t, I don’t know half of these things.

Doctor: (speaking over the top of the patient) do you want antibiotics?

Commentary (Bill): She’s doing a perfect job of completely disengaging this patient. She’s not listening to his concerns about talking about the way he is bringing it up. She keeps talking about what’s different medical treatments rather than about outcomes. The negative approach that she’s taking with him is certainly not going to engage him.

Commentary (Karen): and she keeps talking over the top of him so, he can’t have anything to say. She’s clearly not listening.

Commentary (Bill): Yes.

Patient: there too technical for me even to take into consideration. Look you’re getting me really up tight over this.

Doctor: alright, alright. Well it looks like we’re not going to get anywhere.

Patient: I wouldn’t think so. No.

Doctor: yes. Yes.

Patient: alright, but I probably want to bring it up again with you.

Patient: I would rather you not. I, I just, it’s just upsetting me too much. I don’t think I want to go any further with this.

Doctor: alright. Well okay Ian it is up to you but look, I think it is something your going to have to face up to.

Patient: well just let us agree to disagree. I’m sorry. I don’t want to carry on with it.

Commentary (Karen): Yes. This doctor has continued to focus on treatments and despite the fact that the patient says he doesn’t actually know what they all mean, she hasn’t grasped that concept at all and continues to use the same treatments and just further destroy the whole conversation.

Commentary (Bill): So she effectively starts off talking about how bad things could go and immediately launches into the different treatment options using medical jargon and terminology and doesn’t stop to listen to what’s going on for the patient. Doesn’t talk about outcomes, doesn’t talk about his understanding of his illness, does all the things that are wrong and doesn’t include any of the things she covered in the first scenario.

Commentary (Karen): yes, and even when he actually says ‘I don’t know what all those things mean’, she doesn’t take that as a cue to even attempt to explain anything.

Commentary (Bill): No. It’s all very bad. I don’t know what else to say really.