This video shows effective communication between an elderly patient and treating physician on the subject of informed consent, treatment plans and management care options available.

Doctor: well your blood pressure is fine, and here are the repeat tablets for you.

Patient: thank you

Doctor: and that was easy today so we’ve got a bit of time, and there is something that I would like to talk to you about which was precipitated for me because I was talking to my father. My dad is 84, he’s very fit and well. He plays tennis, but he was talking to me able very difficult things that have happened to his friends and what, how things could be different. And some of his friends have had awful experiences with illness, and he’s scared about that. I just wondered if you had any fears about that sort of thing?

Patient: Yes. As a matter of fact I have, and I think that in my age group and (pause), lots of people in my age are not as well as I am, and you are aware of other people having bad experiences and having to go into care or even into hospitals. I do think about that.

(exploring concepts)
Doctor: so Elizabeth, tell me about what’s important to you for your health and quality of life at the moment.

Patient: I think the most important thing is independence.

Doctor: Independence.

Patient: and being able to get out by myself and engage with other people socially and in organisations.

Doctor: ahh (nodding).

Patient: and generally being able to do everything by myself.

Doctor: any other things you can think of like intellect, or..

Patient: I very much hope that I will be able to manage cognitively until the end of my life.

Doctor: yeah, have you had any particular experiences with people close to you who have had a difficult time with illness or death?

Patient: Yes as a matter of fact I have. I don’t know whether you know about my husband who died last year but we had a really unfortunate experience with him. He badly wanted to stay at home, and he had a terminal illness, and in the event he went to hospital and this caused a lot of discord in the family. Some members of my family wanted him to go to hospital others wanted him to stay at home, and it made the whole situation much worse then it might have been.

Doctor: sounds terrible.

Patient: and in the end he didn't have his wish.

Doctor: he didn't have his wish?

Patient: No.

Doctor: did you know what his wishes were?

Patient: well I didn’t really but, I knew that he didn’t want to go to hospital. I didn’t really know his complete wishes.

Doctor: okay. If that was to happen to you, what would you want to happen?

Patient: I wouldn’t want the discord amongst my family members. Especially I wouldn’t want it among my children.

Doctor: so what your saying is that the process he went through caused you stress, your children stress and he didn’t get what he wanted. Is that what your saying?

Patient: That’s exactly what I’m saying.

Doctor: I’m glad we’ve had this talk today. I’ve been through this myself where I’ve had exactly those fears that you’ve had, and there is a solution for that. I’ve done this myself and I’ll tell you about it and you can decide whether it’s the right sort of thing for you. What I’ve done I’ve created a document. It’s called an advance care directive or advance care plan (pause) that (pause) gives me a sense of security.
There are four important points to it. The first part is it provoked me to have clear discussions with my family about what my wishes are so that in the event of something bad happening to me and I was incapable of determining or communicating what I wanted to have happen, they would know in advance what my wishes were. The second part was that I had to appoint someone to be my agent to act for me if that dreadful thing was to happen. Now, people can choose either a family member or a friend. I chose a friend because the people in my family, I didn’t think were tough enough. I chose someone tough, and someone who knows my wishes and is prepared to argue on my behalf. And the last thing is writing down your wishes very clearly. Now it’s quite a task. It involves a lot of thought, but I found it uplifting to go through. It is a terrific thing to do and it does give me a sense of security.
Here’s a booklet which you can read through when you get home, and if you decide this is the right process for you, you can come back and talk to me about it and we can get the things rolling.

Patient: it sounds like a really good idea.

Doctor: and when you read this booklet you will find there are questions in there which will help you to go through the other steps of talking to your family and talking to your medical power of attorney. They help tease out what your clear wishes are so that everyone is clear what you want. After you’ve done that, if you can bring that back to me, then we will go through the process of getting that put in writing, formally, and then send it to the institutions, the hospitals and other places that might be involved in your care in the future. And hopefully that will give you a sense of security and safety and make things better for you.
I’m really please we have had this discussion. This is something that I think is really important but often quite difficult. I’m hopeful that we haven’t upset or distress you by doing this.

Patient: not at all. In fact I was thinking about it myself but, it is so confronting that I probably would not have raised it myself, so thank you very much.

Doctor: it’s a pleasure.