I think advanced care planning is a real gift not only to medical professionals
who might be involved in your care around the time you're dying but also to
your family and that's the big thing what a gift it is to families to be
clear about what a parent would... wants and so they can carry out someone's
wishes and that eases them through a time that is usually a very difficult
emotional time.
I turn my radar on
and when somebody mentions that they've you've got a friend who's unwell or a
parent I say have you heard about advance care planning?
But I'm also trying in my practice
to normalise talking about advance care planning just
like I talk about future health with asking people how much they drink
alcohol and how much they smoke and just putting death right in with life.
To say that actually it's good to talk about death and what we'd like. Because
death is not an optional extra to our life. We're all going to have to die and
in general practice you're in a really unique position where you've built up
a relationship over many decades with people and it was interesting when I
first started talking about advanced care planning I'd known people for you
know over 25 years but we'd never talked about it and so I'm really trying to
start pushing things forward and starting a conversation. It's not
something you can possibly do amongst a 15-minute appointment.
It's starting the conversation.
So, what I do is, I bring it up. Say' have you heard about it would you like a brochure?' and see
gauge interest and then, if somebody's interested in taking things a little
bit further give them the reading material and ask them whether they'd
like an appointment with our practice nurse to discuss a things a bit further and
would they'd like a reminder in about a month to have a call from the practice
to see how things are going - and I find that I give out a lot of advance care plans
that I never get a completed plan back to scan into the notes but it's the
conversations. So if people have started thinking about something themselves and
also have started talking to families that's got huge value and I see it as
rippling out through the community too just like when people say, 'I'm not
surprised your asking me about how much alcohol I drink Kate because I heard
you're asking everyone. Once you get that momentum going people will be.. feel much
more comfortable about this. But actually getting things written down onto a piece
of paper that we can scan in is very difficult for most people I find
including members of my own family who I have championed advanced care planning to!
You know, I've been a GP for a long time. I've got older my patients have got older, but by golly they're rewarding conversations to have.
People are very grateful, but it's also really great fulfilling you know
rewarding general practice. I think it deepens a relationship with a patient to
actually have these conversations about death and we talk about a whole lot of
different things - why aren't we talking about death it's a really important
conversation, it's really rewarding for both sides of the conversation.
With my own mum when she - we did an advance care plan together because I was championing it and very soon
afterwards we found out that she had an illness that was going
to be terminal, to kill her over you know the next one or so years and she said to
me, ' Kate did you have an inkling of this when you said we should do an advance
care plan?' and I said 'No Mum I didn't at all this has caught me from
left field as well.' And then when she did become more unwell and she was
under the hospice, she suddenly became acutely unwell with trouble breathing
and the hospice rang me at work and said 'We think your Mum needs to be admitted.'
Mum was really clear! She just said to the doctors, 'No! I've already done all that thinking I've
brought in my plan with me - that's not what I want. If I die today instead of in
a few months time, that's as it is - so be it.' I was sitting there not saying anything
not wanting to interfere but she was so strong and clear because she had already
done her advanced care plan including thinking about such a scenario even when
she didn't know that actually that scenario was going to come up in the future.
Whereas, if we'd hit the hospice and she had had to do all that thinking
just then, it would have been really hard. So she actually got better and came home
and lived another two months, and that's life! But she was quite clear in her
decision and that was so helpful for all of us because we knew we were supporting
her and what she had she wanted to do what she'd already decided.