Mr. Fox is a fairly healthy 56-year-old patient whose only medical condition is hypertension, which he controls with medication. He is scheduled for a routine physical examination and is experiencing no new problems or symptoms. Initiating advance care planning may look like the following:
"Mr. Fox, it's good to see you in such good health. I want to take some time today to begin to discuss some issues that hopefully we will have many conversations about over the next several months and years. Have you heard of advance care planning?"
"It is taking the time to learn about choices you have about your medical care if you were ever in a condition that would leave you unable to speak and make your own decisions. If we talk about these issues over time, eventually we will understand your preferences and be able to make sure they are followed."
"No, your condition has not gotten worse, and I don't mean for this discussion to scare you. I try to have this conversation with all my patients so that they have time to get information, talk with family and friends, ask questions and make better decisions. You see, too often we ask these kinds of questions when you come into the hospital or when you are very sick, and we find these are simply not the right time for these kinds of important issues. So we're trying to do a better job of bringing up these issues when you are healthier. Does this make sense to you?"
"There are many choices for end-of-life care that you need to learn about and discuss with your family. Are you willing to begin to learn about them?"
"Please remember that by having these conversations, I can learn more about you and what choices are important to you. The best care can't be given to you if we don't know what your wishes are."
"For today, I want you to read this information and review some practice worksheets on advance care planning. After you learn more about the choices you can make, our goal will be to eventually write them down so everyone will know. By starting this early, we have plenty of time to complete a plan. My main concern is that you understand and make the decisions that feel comfortable to you."
"One of the important decisions I want you to think about is who you would want to make decisions for you if you could not speak for yourself. I would like you to share this information with this person, and schedule a meeting so we can all discuss these issues. You can invite other people if you choose."
"Lastly, I have briefly summarized our meeting today and want you to take it home with you to think about. If you have questions before our next meeting, here is how you can reach me (or here is another resource for you to use)."
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