Mortality. Life choices. Health hazards.
The conversations doctors have with our patients can be difficult.
Especially when we ask about taboo topics.
Learning key series of questions can make complex discussions much simpler.
Key questions I’ve learned and practiced and use on a roll-off-the-tongue daily basis:
What can I do for you today?
(eliciting the patient agenda–not exactly taboo, but so time saving I included it here)
Do you smoke? Drink? Do drugs? Drink soda?
(screening for substance use–both licit and illicit)
Are you feeling down or depressed? Loss of pleasure in life?
And if yes–have you thought about hurting yourself? If yes–Do you have a plan?
Are you sexually active with men, women, or both? How many partners in the last 6 months? Do you use condoms?
(assessing risks for sexually transmitted infections)
Do you want to be pregnant in the next year?
(The One Key Question to elicit reproductive health goals–contraception or fertility planning?)
Memorizing key questions make difficult topics easy to assess.
And now I’ve learned four new questions to ask about what remains the most taboo of topics in medicine: death and dying. Medical writer Atul Gawande shared these best-practice questions in his New York Times essay The Best Possible Day, an adaptation of his new book Being Mortal: Medicine and What Happens in the End.
As patients near the end of their lives’ journey, doctors need to know:
What is your understanding of your health or condition?
What are your goals if your health worsens?
What are your fears?
What are the tradeoffs you are willing to make and not make?
Some have said that doctors asking these questions is akin to launching a death panel. I would disagree. The questions do not reflect a doctor-driven death panel, but a patient-centered empowerment panel. The questions guide patients to choose their Best Possible Life as life ends, and communicate those choices with their doctors.
Luckily, the new generation of medical students is already learning these key questions to guide end-of-life decision making. During their family medicine rotation, Pritzker students interview residents at a nearby retirement home, and their assignment is to practice asking these four questions. I am taking on the same assignment. It will take practice to get these questions to roll off the tip of my tongue, the same way the sexual or mental health questions now do, and so practice I shall.
We will need to practice, as a society, talking about death and dying.