My father surprised me in summer 2013. Dr Atul Gawande challenged and inspired me in his Reith Lectures ‘The Future of Medicine’ November/December 2014.
In the relaxed setting of a two-day break in Somerset with my father, I decided to raise the topic of celebrations for his 90th birthday – some five months away. His initial response was it was too early as ‘something might happen by then’. I countered that this possibility was not a valid reason to delay planning. Instead of sharing my assumption of his preference for the party, I then asked an open question: ‘Have you had any thoughts about what you would like for your 90th birthday?’. To my astonishment he answered enthusiastically ‘Yes, I want a luncheon party (sic) in the village hall with all my friends’. Somewhat shamefully, I had assumed he would want a family lunch in the local pub. So, that was that then and we spent much of the next two days working on the invitation list and discussing some of the practicalities. Sixty-three people came to the party, he made a moving and funny speech and the catering and flowers were wonderful. The guests’ ages ranged from one year to over ninety. My father treasures the memories. My siblings and I followed this pattern of discussion again, in autumn 2014, with his much more significant decision to move 90 miles to sheltered housing nearer family from his much loved village of over 35 years.
This challenge to my thinking was brought to mind as I watched the recorded interview by David Praill, CEO of Hospice UK, with Dr Atul Gawande before his Reith Lectures 2014, at the Hospice UK conference November 2014. The interview was thought-provoking - so much so that afterwards I listened to all the Reith lectures and read his book: Gawande, Atul (2014) Being Mortal: Illness, Medicine, and What Matters in the End. (London: Profile Books Ltd.)
The fact that Atul Gawande is a doctor constructively criticizing his profession and suggesting a way forward confounded some stereotypes. His thesis is that the Hippocratic Oath and the training of doctors has led them to continue to focus on making people better at the very end of life even when the interventions may lead to effects that significantly reduce their quality of life. As patients, ‘We want doctors who promise to fix things’ (46: 2014). He also challenges families who set their relative’s safety and reduction of their own anxiety about their safety as a priority.
Instead he proposes a set of questions that include asking the patient what their priorities are for the time that is left to them. He illustrates his points with case studies of family members and friends.
My father is not in the position of the people Dr Gawande is talking about. However, I now do my best to ask him what is most important in his life, so we may then work out how these experiences can be achieved. I will take these reflections and challenges into my co-facilitation of the Partners in Success workshops for Chairs and Chief Executives of hospices run by Hospice UK and, as appropriate, into other work.