Introduction Terminology

Relationships with anyone Relationships with doctors

People's desires … caused us to create Care Systems
… until the closing phase of life.

Lessons learned Random statistics


ADL Activities of Daily Living:

[ Seems to not include babies nor toddlers.  A family member is barely holding onto these, handling the last item for only two kinds of food. ]

IADL Instrumental Activities of Daily Living:

[ Seems to include most adults.  Tweens, teens, and 20-somethings are picking up these skills. ]

Relationships with doctors

Relationships between doctors and patients [ parents and children? ]:

  1. Doctor Paternalistic (Priestly / Commander / Doctor-Knows-Best) model:
       The original model.
       Tells patient only what they need to know.
       Works well only for vulnerable patients:  frail, poor, elderly, and anyone who tends to do what they are told.
       For reasonably-intelligent, reasonably-educated, reasonably-connected patients, we eventually invented …

  2. Doctor Informative (Technician) model:
       Tell facts and figures, patient decides everything.
       Can work well if choices are clear, tradeoffs are straightforward, and patients are informed and have clear preferences.
       But patients want more than information and control, they also want guidance.  So we eventually invented …

  3. Doctor Interpretive (Shared-Decision-Making / Counselor / Contractor) model:
       Ask, "What is most important to you?" and "What are your worries?"
       Then tell patient what you know, and guide them as to which options will best reach our goals.

    To do this, if you are position of expertise, and need someone to talk about an uncomfortable (but important) topic, say:
     ◦  I am worried.
         Pause, pause, then say what you are worried about.
     ◦  Ask.  Tell.  Ask.
         Ask the other what they want to know.
         Tell the other what you know of the subject.
         Ask the other what they understood of that.
       What are your biggest fears and concerns?
       What goals are most important to you?
       What tradeoffs are you willing to make?
       What tradeoffs are you not willing to make?

Questions may come from fear – answer them.

The job of doctors is to enable wellbeing, where wellbeing is about whatever reasons that person wishes to be alive, at whatever stage of life that person happens to be, at that time.

… caused us to create Care Systems

Standard medical care treatment priority:

Hospice treatment priority:

In terminal illness, that means focusing on:

Job of any doctor [ or 3-Stage Retirement Village 3SRV/​CCRC/​LPC/​LPRC/​LTCF  ] is to:

Three Plagues of Nursing Home Existence:

Let's try to fix that.  Bring in life:  green plants in every room, garden, animals.

Eating alone is not very stimulating.

The chance to shape one's story is essential to sustaining meaning in life.

Lessons learned

… from ideas in this book

📅︎ Way ahead of time, we should:

  1. Create a good:
     ◦  Healthcare Power of Attorney;
     ◦  DNR [ or DNAR or POLST 🇬🇧 🇨🇳 🇰🇵 🇰🇷 🇷🇺 🇪🇸 🇺🇦 🇻🇳; ]  and/or
       other written advance directives for healthcare;
    based on input from the subject and any advisors and stakeholders (spouse, doctor, kids, etc.), and perhaps tailored by jurisdiction.

  2. Store:
       at your main 🏥︎ healthcare provider,
       at your most-likely 🏥︎ hospital,
       [ and on the door of your refrigerator, in a Vial of Life  Adobe Acrobat Reader file (via a form filler > Start).  ]

  3. Ensure that 👪︎ any relatives likely to be there near the end:
     ◦  have these documents and have read them, and
     ◦  are mentally prepared to follow through on these wishes.

Random statistics …

63% of doctors   overestimate future survival time.  By an average of 530%!

17% of doctors underestimate future survival time.

Risk factors for falling (and breaking your hip):

  1. Poor balance.
  2. Taking more than 💊︎💊︎💊︎💊︎ four prescriptions ℞.
  3. Muscle weakness.

    [  One thing that can be done about this.  ]

Cancer costs are ∪ U-shaped:

25% of Medicare spending is for 5% of patients, in their final year of life.

More than half of those living in 3-Stage Retirement Villages 3SRV/​CCRC/​LPC/​LPRC/​LTCF run through their savings.