HW/PC Book Club Feb-2017: “Being Mortal”

I am interested in the the Interpretive Approach for myself. My daughter is a family medicine physician, and this is the approach was trained in at her medical school (University of Washington).

Ask patients what is most important to them. Learn to listen. Treat people as if they know their own needs and desires. The physician’s obligation is not to just give the answer or provide information but to help the person understand his owns needs and how he might best achieve them. In their effort to defeat disease, doctors often make things worse and, more importantly, they lose sight of what is most important for the patient.

The issue of whether a physician's style is Paternalistic, Informative or Interpretive is probably impacted by at least two other noteworthy factors: changes in society over time and physician gender.

When I was a child sixty years ago in the 1950s, society itself was pretty much paternalistic, with respect for authority a valuable and desirable social trait. There are those who would even say that in some ways society back then was in fact oppressive, with issues such as racial segregation, women's rights, and gay rights kept suppressed.

So following this overall pattern of paternalistic behavior that society approved of in general back then, physicians (who were by and large male) generally displayed a paternalistic behavior. (I clearly remember that our family physician at the time, Dr. B----, behaved pretty much in this way, saying things like, with an air of authoritative gravity, "This is what's wrong, and this is what you need to do to treat it", with my mom and dad making it clear to me that even questioning anything he said was unacceptable).

Then came the 1960s, with the Vietnam War, and issues of civil rights and women's rights (though women's rights were actually more prominently dealt with in the 1970s) when unquestioned respect for authority declined, and the questioning of it, sometimes extreme, dramatically increased.

So it would seem reasonable then to suppose that, following the radical changes in attitudes toward authority that had been developing, physicians then followed suite (perhaps even acting subconsciously) and began treating their patients with more Informative and Interpretive approaches than before. In doing so they were just "keeping up with the times."

Physician gender may be a factor as well. With career opportunities for women expanding significantly following the social changes of the 1960s on, becoming a physician, not a nurse, became a more common possibility for women pursuing a career in medicine. So would these newly developing female physician have tended to be more Paternalistic, Informative or Interpretive? Well, since studies have tended to suggest that female physicians tend to listen to their patients better than do their male counterparts, perhaps they naturally evolved to be more Informative or Interpretive.

So, modeling all this, perhaps physicians can thus be "grouped" as

Male Paternalistic
Male Informative
Male Interpretive
Female Paternalistic (Maternalistic?)
Female Informative
Female Interpretive

with some of these groups occurring more commonly than others. (Maybe not so many Female Paternalistic, for example).

Who knows, perhaps the terminology might catch on, and those physician evaluation websites that exist might pick up on it and use such terminology in rating physicians?

JackH –

What is the best approach of the three? Well, all three approaches are certainly capable of imparting information, doctor to patient.

A given doctor may have a preferred style of delivering information, one he/she is more comfortable doing, or a given patient may have a preferred style of hearing it.

And I suppose a really attentive and sympathetic doctor could even vary his approach to suit a given patient, assuming he had learned what approach the patient preferred, and was willing to tailor his approach accordingly.

So which approach is best depends on what is best for the given patient, the approach that does the best job of getting the information to that patient, and the one the patient is most comfortable with. So the answer to the question "Which approach is best?" is "It depends on the patient, and what the patient wants/expects."

For me, the Interpretive approach works best, and that includes end-of-life discussions/decisions As my journey has gone so far, I have always wanted (actually insisted on, whenever I could) to be part of the decision process. I think an exception to this preference of mine did (maybe had to) occur during my RT, when my RO and her team said, in essence Paternalistically, "This is what we will be doing, here is the schedule, and here is what you must do to comply"). Otherwise, I see treatment is a team event, and I see myself as one of the players.

In essence we are talking here about communication here, and that means different strokes for different folks.

OK, we've had two weeks of discussion period, so I want to ask if there are any other last thoughts amongst our participants on the book, Being Mortal?

Also, if you collected any memorable or noteworthy "quotes" from the book, please share them here in this thread.



Soon (in a few days), we'll gather process feedback from participants and discuss possibilities for a new book to read/discuss in the Mar/Apr timeframe.

compiler said...

Anyway, I cannot imagine dealing with a totally paternalistic doctor these days. Yes, there are still folks who might have an unquestioning approach in dealing with medicos, but their numbers are greatly diminished.

Perhaps greatly diminished from the majority that they once comprised, but I am amazed at the cadence at which they continue to show up at HW/PC. We often "convert" them into being stronger self-advocates, but how many more are there who don't stumble upon HW/PC? Many. And many people do still want that paternalistic relationship...nothing wrong with that, but the book helps illustrate the when and where the differences can be powerfully realized.

One of the good quotes from Being Mortal:

“Our ultimate goal, after all, is not a good death but a good life to the very end.”

"All we ask is to be allowed to remain the writers of our own story. The story is ever changing. Over the course of our lives, we may encounter unimaginable difficulties. Our concerns and desires may shift. But whatever happens, we want to retain the freedom to shape our lives in ways consistent with our character and loyalties"

HW/PC Book Club — new book recommendation/selection process

Gentle readers,

Thank you for your participation—reading and discussion of Being Mortal—in Jan/Feb as part of the HW/PC Book Club inaugural “meeting” cycle. I’m pleased that at least most of you seem to have found the book to be worthwhile. Counting myself, we had nine participants in February during the “discussion” phase…not bad. We also had three who seem to have dropped out after confirming their participation in January…and that’s ok; people get busy with other things, maybe they didn’t finish the book, whatever. That’s ok. It’s truly intended to be for fun, or entertainment and/or additional shared knowledge, and so if any of you who signed-up but didn’t participate in February wish to participate in the future, the door is still wide open…but again let me conclude this paragraph with a big “thank you” to those who contributed to the discussion in February!

The next steps I laid-out back in early January is that the participants from this cycle (the Jan/Feb cycle), make a book selection in late-February for the next cycle (Mar/Apr). If we don’t pick a book here in about the next week, then maybe the Book Club is one-and-done. It’s my hope, however, that we’ve got enough momentum to keep it going, and possibly even grow. Let’s see how this goes…

Before going further, let me add that if anyone is reading this who was NOT a participant in the Jan/Feb discussion of Being Mortal has an idea for good book for the HW/PC Book Club, please join-in once as a participant, and then you will also become eligible to make suggestions/recommendations for the next book cycle. Just to be even more clear...everyone is invited to participate in the HW/PC Book club, and we will always encourage and look for newcomers to join, but we ask you to join once as an active participant before becoming part of the recommendation/selection process to choose a new book for the next cycle—sort of "paying your dues" first—so please watch for a new thread starting on about March 1st soliciting for your participation in the new book cycle.


So, I’m opening the floor (to participants) for open suggestions/recommendations of a book for the Mar/Apr cycle.

Please note that there are two pre-requisites to making book suggestions/recommendations. (1) Please recommend books that have some sort of connection to why we are all here at HW/PC. This is still pretty wide-open and all you need is to be able to make a fairly loose, but legit connection…but some sort of connection nonetheless. (2) Make a suggestion/recommendation only if you are willing to fulfill the role of Book Club “facilitator” for the two-month period of March & April. I described the role of facilitator in the Guidelines (#4) I published way back in the very first posting of this thread:

Facilitator shall “take the lead” for the 2-month period by initiating and maintaining a new “book thread” on the topic once the book has been selected. During the “reading” month, the new facilitator shall encourage new participants to join, stimulate interest in the book by posting “teasers” (without giving too many “spoilers”), and track who will be participating in the “meeting.” During the “meeting” month, the facilitator continues in the “lead” role by asking stimulating questions of participants and helping to steer the discussion and keep it on-track.

I have gone back and added two more sentences to make the description more complete and self-sustaining:

In the 2nd half of the "meeting" month, the facilitator leads an effort for current participants to recommend/select another book (and facilitator) for the next cycle. Each facilitator's responsibilities come to an end after the 2-month cycle and a successful hand-off to the next facilitator is complete.

In general, it is my hope that my posts in this thread may serve as an illustrative example for other facilitators to follow in the future.



So participants, if you are willing to also facilitate your recommendation during Mar/Apr, what book would you like to suggest/recommend for the Mar/Apr HW/PC Book Club?



Let’s see if we get a book selected, and if we do, then perhaps we’ll also see if there are any “post-mortem” comments/feedback on how we might have improved the process/experience from Jan/Feb so that the Mar/Apr cycle can be even better...let's keep these steps separate; book selection first.

Post Edited (JackH) : 2/22/2017 3:14:03 PM (GMT-7)

What Patients Say, What Doctors Hear by Danielle Ofri. I have read several of Dr Ofri's books an liked them all. This is her newest book, which I have not read yet.

The other books written by Dr Ofri that I've read are What Doctors Feel, Incidental Findings, and Medicine in Translation

Thanks Tim G and redheadskier...thanks to both of you for putting forward a couple suggestions for the next cycle. I'm guessing that nobody else has any suggestions, or is holding them back for another meeting cycle when we run out of ideas.

Both books look good, and a bit similar (and some similarities to the Being Mortal book, in different ways).

I assume it's been clear enough to both of you what your role will be as "facilitator" for the next 2 months—starting a new thread, and keeping it going thru the reading & discussion periods, and then getting the next book selected before handing-off. If there's any reason that either one of you didn't want to do that, or wanted to put your book off until a future cycle, now'd be the time to speak up on that...otherwise we just need to pick one between these two choices. We certainly could end up reading both books...one this cycle, and the other later on.

So I'm up for either book...and would like to see if there's any other participant inputs in selecting between these two books...?

I'll read them, but what's your thought?

81GyGuy, thanks for adding your own comments, and for the book links.

I agree that both could make for good discussion here, and I think I'd be interested in reading either. I am particularly interested in the What patients say, what doctors hear because I am often telling people (most recently my wife) to be sure to have a conversation with one's physician, not just a spewing of facts. I strive for that myself, but sometimes it is just plain difficult to communicate clearly and effectively...and I'd be interested in improving that as a skill.

redheadskier, if you'd be willing to raise yours as an option next time...and in the absence of other conversation on this from any other participants over the last few days, I'd propose/ask that Tim G lead the HW/PC Book Club over the next 2 months through the reading/discussion/etc of What patients say, what doctors hear, by Danielle Ofri, MD.

Any other comments/feedback on this?