Commentaries from the experts - 'Putting pen to paper'

Doctor: oh look thank you for coming back. Last time I spoke to you, and I’m glad you came along too, (wife: thank you) we talked about the, your long term health care and planning for that. So how have you gone with that? I noticed you’ve got some of the paper work there.

Patient: we have some of it filled in. There’s a few questions there, we sort of have to go through with you.

Doctor: okay

Patient: we both studied it together (doctor: yes). We spoke to all our children. Then we offered them the choice of whether they want to be our, one or two of them wanted to be our power of attorney.

Doctor: right, okay.

Patient: but they feel they’re to close to us for that.

Wife: they didn’t want to do it.

Doctor: okay

Patient: so we decided then that we would ask a family friend of 30 years to be our power of attorney.

Doctor: okay

Patient: the nurse in the family was the one that asked the most questions which is probably natural.

Doctor: yes, and so you said that you have a family, a friend that you have decided to appoint as your power of attorney.

Wife: yes

Doctor: so how did you go about asking him?

Commentary (Bill): It’s nice the way she’s started this conversation off. She’s very relaxed and she’s clearly pleased to see them here. She’s not making it to be a morbid sort of topic. It’s a normal conversation and by being relaxed, she’s putting them at ease as well. Presumable this is the first time that his wife has been here for this discussion but you can see she’s quite comfortable about it, and you pick up immediately that they’ve been talking about it before hand don’t you?

Commentary (Karen): Well you do and yes again, I think his wife would feel quite comfortable in this as well because the doctor was very welcoming, and they have clearly gone away and talked about it and taken it all on board which reflects the good conversation that she had with him last time and how she had him so engaged in the process, so it’s all good.

Commentary (Bill): and not only has he listened to the right person to appoint as the substitute decision maker but they have read the literature because they have decided to appoint a family friend rather than one of their kids.

Commentary (Karen): And it’s also good that the doctor checking on why they’ve selected what they done just to make sure that she doesn’t need to discuss it further.

Commentary (Bill): Yes.

Patient: Oh well we have known him that long he was more than willing to help us.

Doctor: Good. So how much detail have you gone into in the actual plan? There is quite a bit of reading here to do. So, what have we got so far?

Patient: We’ve filled out the power of attorney side of it. Ah, but we felt we needed a guidance whether we tick one, two or three.

Doctor: Yes. absolutely. Okay.

Patient: we needed to know that (pause) what we ticked here gives us the outcome we want.

Doctor: Yes I guess that’s the issue isn’t? (Patient & wife: well it is the issue) Knowing what the outcome is that you want.

Patient: that’s right

Doctor: Yes. So, I guess I can go through and explain to you what these procedures actually are in a medical sense and what circumstances perhaps they might be performed in and, and, and to you, I’d like to know from you what you feel an outcome is that is acceptable to you because of course that is going to vary from person to person.

Patient: person to person.

Doctor: in that first question there about cardiopulmonary resuscitation or CPR what it actually is and possibilities in outcomes. So, so once you understand what….

Commentary (Karen): we didn’t see it all but obviously she would have gone through in detail what it meant for him, what the likely outcomes would be and whether the treatments would actually help him achieve the outcomes he wanted..

Commentary (Bill): Yes.

Commentary (Karen): so he knew which boxes he might want to tick on the form and whether he wanted to tick any of those boxes.

Commentary (Bill): It’s good relating the treatments to the possible outcomes so he can understand that. Yeah.

Commentary (Karen): yeah and most of that is actually about the conversation rather than the actual document, and his wife was obviously there able to listen to it all as well which was fantastic.

Commentary (Bill): Yeah.

Commentary (Karen): It would have been really good to potentially have brought along the substitute decision maker as well so they could have heard this part of the conversation in detail as well because ultimately he’s the one that may well be in the situation needing to make the decisions.

Commentary (Bill): Yes. I agree. I think that’s the one thing missing from this. They have talked about appointing someone else as the substitute decision maker but they don’t actually have him there. They’ve got the wife. Let’s see if the GP addresses that in the subsequent discussion.

Doctor:  okay. Well I’m glad we’ve gone through all that, and that seems to make a lot more sense to you now?

Patient: it does.

Doctor: yes. So I guess all that is left at the end now is we need to sign off on the statement of choices form and then we’ll go through a little summary to make sure we have everything in order. Is that alright?

Patient: That’s fine.

Doctor: I just need you to fill in just down there. So this is basically saying that the information completed above is a true record of your wishes, dated today. And you will need to sign it, and perhaps I could get you to witness it for us since your here.