- What is your understanding of where you are with your health?
- What are your worries for the future?
- What are your hopes and priorities?
- What are you willing to sacrifice, and what are you NOT willing to sacrifice?
I have actually seen this documentary before in an LSW (licensed social worker) prep class. I remember being incredibly moved by it the first time around, and having quite an intense emotional response. This documentary is so important, and I was moved (for the second time) at the candidness of Dr.Atul to acknowledge his own mistakes and dedication to have these difficult conversations in order to have more positive outcomes in the future. Other doctors may have not been so willing to point out their short-comings, and so dedicated to change.
When Dr.Kathy Selvaggi brought up that doctors need to be asking their patients where they think they are in their disease progression, something clicked in my brain. I worked with the elderly, and often sick, population for five years and this was a common issue- people not knowing the full extent of their health problems or conditions. It’s important for physicians, or any other professional, to ask their clients what their perception of their health is in order for everyone to be on the same page. You may think that someone understands what you’re telling them, but you really don’t know unless you ask. Patients also may be hearing only what they want to hear, and it’d be important for them to have further education in order to get the complete picture. The answers to the several questions could change over the course of the individual’s illness as the reality of the disease or condition manifest. It’s important for social workers to be asking these questions as well as it is for the medical professionals involved.
With a client that is open with their communication, it would be easier for me to ask these questions without “beating around the bush”. The client may even bring up these questions themselves. The first question of “what is your understanding of where you are with your health” would most likely be something I ask at the beginning of each meeting. This would give me insight into what the patient is hearing, what they may need clarification on, and what they are willing to admit about the spectrum of where they are with their illness. Asking about a patient’s worries about the future is something I might touch on at the first meeting, and then as needed throughout the rest of the process. I wouldn’t want to perseverate or have my patient/client perseverate on what their worries are. I would do my best to address their worries early on, get any advance directives in place, and ensure that the client knows what to expect long-term. Hopes and priorities can change throughout the life of an illness, some may prefer to take it day by day while others want to make tangible goals. I would do my best to ask this as often as needed in order to best serve that individual.
With a client that is not particularly open to communication there would be gentle prompting throughout the course of our meetings. I would not necessarily want to ask every question at the first meeting and would stay cognizant of the client’s emotions, body language, and reactions when we did talk about the “hard stuff”. I think I would ask about the clients understanding of their illness when I saw an appropriate opportunity or towards the end of the first meeting. Unlike a client that is open with their communication, I wouldn’t want to jump right into talking about the illness. I would want to give time to build rapport, start a conversation and get to know them before I asked a personal question. At the meetings following that first meeting is when I would open the door to asking about their worries, hopes, priorities, and what they will or won’t tolerate.
All of these questions have the potential to change throughout the course of someone’s illness. What someone wants to prioritize at the beginning may be the last thing on their mind once their physical ability starts to decline. It would be important to ask all of these questions at different points of the client’s illness regardless of their communication style. Most of all I would encourage my clients to advocate for themselves, or at least let me know if something isn’t working for them, so that I can best serve and advocate for them.
Link to the documentary: https://www.youtube.com/watch?v=lQhI3Jb7vMg
