Written by Panorama resident, Judy Murphy. March 2016
The Wednesday discussion group of 22 people was small enough to allow a give-and-take among the facilitator and the attendees. We focused on the Shared Decision-Making model of the patient-physician relationship, discussing choices that patients need to make and the obstacles to making them. In shared decision making, the physician presents options and the patient makes choices with the physician’s guidance. This model was exemplified in “Being Mortal” by Dr. Gawande’s father’s terminal cancer diagnosis and how he and his family responded to it. The importance of communication with family and medical providers was emphasized. Several people mentioned that we need to be cautious about information we find on the Internet and suggested that second opinions and fact checking are very important.
Other topics surfaced as well, such as what constitutes quality of life, particularly for someone with dementia. Concerns expressed by residents included how to make your wishes known well in advance of illness, being sure the family, physicians and institutions have appropriate paperwork, and the need for families to come to an understanding and acceptance of the parents’ wishes. Children do not always agree, and if that is the case, the medical power of attorney is extremely important.
Obstacles to making appropriate decisions included
1) Expense of medical care that could impoverish family members
2) Regrets about one’s life and poor choices one may have made
3) The wish to please family and physicians
4) Not acknowledging that one is dying
5) The desire to not burden spouse and family.
We also discussed differences in cultural attitudes towards death and dying, the need for us to face these realities, the importance of palliative care and hospice, and the gift of having time to say good-bye to friends and family. One suggestion many found helpful was writing letters to children about your feelings and things that are meaningful to you. A common sentiment was that the dying process gives us an opportunity to enrich our relationships with others.
All agreed that living at Panorama is a gift in this regard, and the need for facing difficult subjects is made easier by being able to talk about them with like-minded people.