My summary notes from the wonderful book, “Being Mortal” by Atul Gawande.
ADLs
Eat, toilet, bathe, groom, dress, get out of bed, get out of chair, walk
IADLs
Shop, prepare food, housekeep, do laundry, make phone calls, handle meds, handle finances, travel
THREE PRIMARY RISKS OF FALLING
Weakness, loss of balance, taking 4 or more medications
QUALITY OF LIFE means as much freedom from the ravishes of disease as possible and retention of enough function for active engagement in the world
LIFE PRIORITIES – Maslow’s “Theory of Human Motivation”
- Basic needs – survival and safety – food, water, law, order, stability
- Love and belonging
- Desire for growth – goals, knowledge, skills, achievement
- Self-actualization – moral ideals and creativity
AGING SHIFTS PRIORITIES to being instead of doing, to the present instead of the future
PHYSICIAN-PATIENT RELATIONSHIPS
- Paternalistic
- Informative
- Interpretive – shared decision making
WORDS TO USE
- I wish… I am worried… Ask, tell, ask…
THE SICK AND AGING have priorities beyond merely being safe and living longer
OUR JOB is to insure “well-being”, not just health and survival
QUESTIONS FOR TERMINALLY ILL PATIENT:
- What is your understanding of where you are with your illness?
- How much information about what is likely to be ahead with your illness would you like from me?
- If your health situation worsens, what are you most important goals?
- What are your biggest fears and worries about the future with your health?
- What abilities are so critical to your life that you can’t imagine living without them?
- If you become sicker, how much are you willing to go through for the possibility of gaining more time?
- How much does your family know about your wishes and priorities?
