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Starting the Conversation

I'm really, really thrilled to introduce dr tony bok friend and co worker we've been talking about wanting to work together, and so when I thought adding a part about communication, we've spent the last day and a half talking about some things that are very, very important and talking now about talking to the people who are important to us and who better than expert about talking about it, then, tony so, tony, I you do so many different things. Can you talk to me and everyone and introduce yourself in a little bit about the work? You d'oh? Sure, thank you and thank you for the invitation. I think this is a great event, so I'm excited to see how it turns out. So I'm a physician at the university of washington and the fred hutchinson cancer research center. I spent part of my time seeing patients with g I cancers like colon cancer, rectal cancers and their families, and then I do ah, bunch of research looking at how doctors and patients talk to each other, we audio record them, we video ...

record them do stuff like that, and I am the co director of the center for excellence in palliative care at the university of washington, and so one of the reasons why, I mean, you spent a lot of time. Talking to people about talking about things, and in addition to that e, you're right, you're right, and then some work that you do with another project called vital talk, and you know, that you also go all around the country talking to people about this project. So in fact, we were just last week doing a project with the american cancer society, where we were working with oncologists all over the country, who were learning to talk better, learning to talk about difficulty subjects without backing off, learning to help people make difficult decisions without bailing on them. And so that's been a really interesting part of my work, and we've created this nonprofit called vital talk, to try and disseminate this work more than I could do in kind of a research way, yeah, excellent, well, one of the things that I wanted to say on we've been going tio our example of a purple goldfish and a big full of many gold gold fish is that it depends. And so in a lot of times, we talk about even on on a medical level or on a choices or priorities level, and talking about this with her friends and family and loved ones when we're asking somebody to be our medical power of attorney, yes, a lot of it depends on personal choice and so I wanted to say really quickly that we're talking about talking about it we're not giving you specifically medical advice here's my little thing you're all used to seeing always find out what you need to find out from who you need to find out about it before you make decisions or sign things always always always always but there's a couple of things about communications and we've been talking about the holidays and referencing the upcoming holidays as well and so we all have a lot of joy and anticipation about the upcoming holidays and we also many of us also have the that clinching feeling about oh having to do that again or here's the argument or you know, not getting through it but enjoying it so kind of cracking open some of the work that we've done here and bringing it to the table whether it is not being allowed toe sit at the table unless you signed the document as in one situation versus here is an opportunity where I'm going to lightly bring up something in a positive way and plan to see that I want to watch her over time to grow into something so setting up a talk to go well is always an important thing to think about and then also one of the reasons why it's hard to set up a talk to go well is because we're afraid it isn't going to go well so can you talk a little bit about when you're working with people and it's sometimes it's a clinical environment but being a medical advocate for yourself and your family is a huge thing to talk about hard things what are some of the things that we can do quickly before we jump into the doing them for setting something up to go well right so I could mention two things yeah, so one thing would be uh I haven't really concrete reason why uh you want to do it either to be better prepared or because you had a friend where you saw it didn't go well and know it could be better and then the second one is I think just prepare yourself for a little bit of awkwardness because a lot of times people go who when you first bring it up but if you can get through that first little reaction actually a probably do great but don't let that first little thing put you off so those my two brief tips for getting strike forgetting yourself prepared right and then when we're practicing some skills and some tools to make when uncomfortable moments happened how we make those easier yes what might seem a little guiding light moments for them? Well, so one thing was, you know, talking about how you could expect things to be awkward and you know, you probably know your your relatives well enough to tohave a little heads up on that but I think the thing about it is is most people process this kind of information in kind of an emotional way and an informational way and you know, my big rule is expect the emotion to come first and if you can hang in there with it it'll often kind of subside and then you'll be able to really really talk, right? I mean, this is like if you've ever gotten bad news you know the first thing is your life well, I'm kind of discombobulated and then yet if you have a chance to settle down then you can do the real work and the same thing is true about talking about medical power of attorney right? Because in the way that brings up this whoa they think you know I'm going to get sick or she thinks she's going to get sick or what does that mean? Really? And, uh you have to let that pass a little bit right? As I just mentioned yesterday talking about wills and living wills and none of us died while talking about it their personal proof right here, right? Progress already progress already that's right? Well, so the thing about communication and this is one of, like a gazillion quotes about how communication is tricky, right? But effective communication is twenty percent what you know in eighty percent how you feel about it so especially when we're talking about things that are harder, tricky or talking about feelings it's there's a lot of room for miscommunication, misinterpretation for things to go wrong and then this is one so talking about them is important and then disagreeing sometimes happens and being okay with that and knowing ahead of time, even if you you know, ahead of time that you disagree that's even better than not knowing what might be coming at all right? Right? So here's something that I wanted to back up with for a second. So this is this is something that's been around since, like the advent of time, how a message is received and how it is communicated, so when we're talking a little bit more, the fifty percent body language, forty percent tone of voice and ten percent actual words. So how how do you use that when you're talking to patients and doctors about understanding each other critical information that you want them to under actually understand? Yeah, well, the thing that I think this points out this body language thing is, you know, in a way your body is sending messages all the time, so if you're not really ready or you feel a little uncomfortable that'll really telegraph if you're if you're coming across now, this doesn't mean you have to be completely com it doesn't mean you have to have it completely worked out because the reality is, you know, talking about this is is a little tough and so I think you just have to be calm enough that you feel like you've got a little bit of peace of mind because if you're all riled up in your life this's gonna be like then actually should just wait a few minutes and maybe do it with the next course or didn't find having a glass of wine or do something because if you really don't feel ready it's okay to to give it a path you know to give it a pass for, you know, a couple hours sure, that reminds me of something that, uh there's a phrase that somebody told me when I was doing dog training and I'm not talking about talking to your aunt's a bit like dog training, but tension runs down the leash is essentially so your antenna is broadcasting out how you feel and if you're tense and nervous, the message is going to probably be relieved is tense and nervous as well well and you know, can I bring up one other dog training thing? Is it's all about positive reinforcement, right? So if they do even a little bit with you thank them right make sure that they know you really appreciate it because it's all about positive reinforcement right by the end of this will just be doing dog training we're just gonna blow that we're gonna blow this whistle if you'll just sign your living right just gonna click there is I'm going to get it clicker and then everyone's that's workshop number two all right, I think we've offended now half of you know, so a couple of things as we've been talking about the holidays and so I would like for us to imagine a little bit like there's an opportunity for us when we know doing something now um is better than doing something never and that the holidays are coming up and we're going to be with them anyway and we most likely or on the phone or touching base often with family at some point over the next couple months if that actually isn't the case, then we're hitting one of those end of year milestones where we get very likes a milestone e you know, and we're all going to be bombarded with new year's resolutions and so if if it's really important that you finally paint your bathroom let's, just get your will out of the way you know and clear the runway for that to happen so how might we take a tough conversation to the table? And we had one example yesterday about a thanksgiving dinner where nobody could could come to it but are their ideas I know uh you chase happened towe have you were mentioning holidays and that's usually when your family gets together and that you and your dad for example yesterday both of very different opinions about a living will but that doesn't necessarily mean that you don't you both can't have a living will right yeah I'm we have extreme different views on you know how and should go basically but we have no like we can talk about it very openly so it's not really an issue we've you know we've always talked about oh it's not going to share I do it all since I wasn't here yesterday would you mind giving me a little teeny bit of how you're different? Well he liked every measure to stay alive as long as possible got pumped full of all the drugs and the unicorn blood and everything you know no matter what to the bitter end and I'm like I don't want to suffer it all you know no comas no nothing right god thank you yeah okay you know that's a great example of how to how to talk about uh this was somebody where you know things are really different yeah, right interesting and then the other part of that is since we're clearing the runway for more things that we want rather than things that we don't want is with the new family newly married and also recently married and pretty new still rolling baby coming that the table is also a time not just to talk about the things you don't agree on but the things that you do you agree on what you want and what you're grateful for and those you know spending and your values and so what better time really then you know the holidays which are supposed to be about gratitude so how would you with that sacred space be no it's e and I my husband and I haven't had that conversation yet honestly I mean I think I can I think we might be on the same page but it might yeah absolutely we'll talk about it if not over thanksgiving dinner I mean maybe tonight, right? Sure with your relatives over dinner here in the papers I haven't talked about it with my family either honestly, my mother is just her while she's sixty um and we haven't discussed that yet which I now I'm just like why haven't I talked about that yet I'm the oldest child and yeah it's it's conversation that needs to be had for sure yeah, but it's kind of scary it is it's but we'll walk you through it okay? It'll be okay it'll be okay we'll keep it kind of lighthearted it doesn't seem to be scary, you know just right normal conversation it's not still going into it like too heavy and it seems to be fine for me at least well, you know well, I was just going I've got a whole bunch of things for rolling through my head um my wife has a physician as well and so she she could be very clinical like and there's a very open dialogue but there's no like hemming and high I mean, you put it on the table, you talk about it, get it off, you get a move on, you know, it's very type a business I think he does get that med school, don't you? Totally no, we're totally all about that absolutely so at any rate, I mean, she and I like to role play the discussion that we'd have it I'm going to show up at home with this binder and she's going to say, you know, what's in the binder, what can we get through some of that tonight? And then maybe we can finish it off tomorrow, you know it's like, ok, and I'd be the uncomfortable one and normally that's not the case, but the conversation with the mob thing or dio a father on end of life stuff I own a funeral home for god's sake and it was the day before my mom died I'm like, I know we've had this discussion, but it becomes really awkward the closer to whatever crisis it is, yeah, so for me to say you sure you want to be buried or cremated I want to be cremated that's you know that's fine at this time because it's not approximate but the closer you get to it the more awkward and uncomfortable it gets into the day before my mom died I'm like hey mom I just got to ask do you want to be cremated is that what we okay yeah I think so okay then right who's super awkward so I think it's so important even if it is awkward over the the turkey to be having this conversation it's way easier over turkey that's going to be in the hospital so right that's an excellent excellent way to look at it yeah yeah so sorry for the way I love your way well and it's interesting and so then there's talking to you the immediate people and then there's rolling that plan out to friends and family so too uh your closest relatives and hers and your closest relatives on dh then guardianship yeah it's better if you pick yeah, yeah yeah and then that's very interesting. Sometimes you get warring grandparent's about who's more awesome. Yeah, yeah, we should get the baby and we should get that maybe he's like stop it I'm still here I'm yeah I get the baby yeah, yeah, right well and so one of the things that we've talked about and this little binder um that you get to take home way have definitely talked about what do you want to achieve her accomplish so having a conversation about I'd like to have a really important conversation with you about life or death and they say oh great you want to talk about what do you what do you want to what do you say you're like oh you know I just kind of want to chat about it you know that could go well or it could not but if you have a goal or something in mind or something specific having having a knowing what you want to accomplish is a great way to help prepare for and then steer the conversation to get to there and so in the first page of your workbook if you we can think about even if it's just in context of we have some financial worksheets and insurance questions for you guys to follow up on wills and living wills what are these things now that you have that you want to start accomplishing first and how might you start engaging those people in that conversation to get those done it could be a can I have that trust fund now or could be a here's where my money is in case you ever need to be able to find it and get access to it so when we first started off we had three big questions which was what's keeping you up at night and what are the things that you know you need to do already? And then what what do you want to accomplish? And since then we've had a big list of a lot of details that might then ladder up really into let's get rid of the things that keep you up at night and let's just take care of the stuff that you already know you need to dio and so if we could take just a second to think about rolling this plan out and how you want to do that and what will make you feel better to accomplish first wait a second you don't have to start with the most with the biggest hairiest exactly right could be here with an easy right? Yeah, one easy thing right down your pin number the pin numbers a pin number right down your pin number and how you're going to do it? It could be it doesn't have to be everything we all want accomplish a lot of things which is frankly a great thing about us but yeah, one or two things and what we're doing that we only have like twelve things weaken role play is very exciting, okay, I know okay, but um once we start thinking about what we want to accomplish, then we want to think about in the next page chair is about how do you feel like you have the tools and skills like where? How are you comfortable to do this and maybe one of the areas in which you might want some extra support? So when we talked a little bit about the workshops that you do all over the place, this is one of the key areas that that you start. So would you mind sharing an example of one of those role plays, or how you get the doctor and or the patient comfortable, yes, or familiar with what they're good at? Maybe where they need help? So, you know, for example, so one of the things I'd be thinking about, which is right along the lines of what you're talking about, is what's something to start with? That is a meaningful thing, but that isn't too hard, because I think of it is like these tough conversations are like a skill, so if you think of it like, you know, learning to ski, right, we wouldn't say, ok, double black diamond first push, right? We want to do something that's a little easier to manage. So that's, why it's a start with something that seems pretty doable? Have a little success that will be some positive reinforcement, then you can build up, build up your way to the tougher things, so, like the cremation, the the burial thing that's like a hard thing so I say we should start with something we should for a lot of people that's hard so I'd say we should start with something a little bit more like the blue dot kind of thing start with the blue dot yes start with the blue taw right? But we're game for whatever whatever seemingly could be worth trying you know one of the things that the doctors are always think this's like role play it's fake you know and the reality is it is fake but you know the fate can be good because you know it's low risk I know you will get yourself into too much trouble because you could just say time out right well and also the way that you would practice a speech before you go out and you know, sometimes just saying something out loud is is a great way to start so getting ready so one thing that you want to accomplish and it could even be you brenda you were talking about the details piece actually a little while ago that when you first if I could share that when you when you first did your will ten years ago he went home last night and found it and compared the difference between that one in this one yeah, these uh the world has changed right especially so much in the digital world and knowing where information is and how to access information and all the passwords we were talking about and even the decision we had a little bit yesterday about do I want my facebook profile to live on, you know, or do I want it? You know? I mean, which is something you have to think about it? We're going I mean, it's a weird thing, and so I did I looked back over my documents from the last time I did this and even looking at who I picked to do certain things has changed their lives of change uh, one of them is my dad who we've talked about is struggling with alzheimer's now, so he's, maybe not the good person haven't charged my finances anymore, you know? And you don't think about those things, but it is time to revisit and I mean just in the fact that people's lives can change, but also just because the world changes in your own circumstances changes so often so yeah, time to revisit all of those things. Yeah, less people had less email accounts and yes, digital things everywhere yeah, ten years ago. Well, and you know what that reminds me of another story you shared yesterday about your friend and contacting people, yeah, that a friend of yours had moved away and you realize that you didn't know howto get a hold of her and her new friends and a new location may not be able to get ahold of you write so that might be a good yeah early conversation to bring up about how we might or how you might want to be ableto know how to reach her and or state closer and tough yeah I've been thinking about that a lot with all my friends because we are we live in a very distributed world now you know it used to be families if you really couldn't get a hold it someone you drove down a few blocks and hung out and looked in their windows or whatever you know to figure out where they were now you can't do that there's you know you've meet friends they move on there's three thousand miles away suddenly realized you don't know who their network is anymore you still know them but you may not be aware of who their friends are how to contact them and in this case we actually she was live fairly close to her parents but we her parents are elderly and we didn't want to alarm them for no reason either and even trying to find their actual phone number was as opposed to an email was a challenge for us so it's like just time I'm a list person I'm going to start making lists you know of things that have to be done when it is though yeah yeah, well, from peace of mind for all of us, the place well, I love that. So these air the tangible, small, tangible things, which is a pin number and a phone list. Yeah, or conversation about signing each other's documents. So even if you and your dad disagree about what you want for each other, would you be able to advocate for the other persons wishes knowing really clearly what? What? They were right? Yeah, which is different than four numbers. Say that one could be over dessert. Yeah, over dessert later. So when you think about having these conversations and having, like, a goal you want to accomplish and then bringing it up kind of getting ready and getting started, do you? How how do you do you feel comfortable getting ready and going in, like, prepping yourself toe have the conversation, whether it end a brilliantly or gorgeously or whether it itv being a good first step in many to come, how might we steal ourselves to get the positive result that we want? So when you're talking with doctors and patients someone's going to go into a room and have a conversation with somebody about something important, so are there talking techniques or listening techniques or if you get that you guys practice well, so one of the things that I think that I think might be worthwhile here is on, I don't know does someone have, like an example of something of the kind of thing that they think about is an early first step, one of one of you guys be willing to give us an example of something we won't make the first step of some one of these one of these conversations that she was talking about, I I actually have one coming up with my dad that I was talking about, so he has his will, but I cannot find anywhere I think he has it, I cannot find any of his people ways and so, you know, you know, you don't have the document that has this power view well, and I think it's me, I'm pretty sure it's me, but I can't find that on and because now he's starting to feel that loss of control of his life, he's early stages of alzheimer's, but he knows it's going and so trying to broach that subject is sort of like, um, I was going to say the nail in the coffin, and I thought that's not a good thing to say, but, you know, I don't mean to start to prepare so it's sort of that he is slipping and he's, even though he knows that he doesn't want to really admit that he's losing control could you use us an example just to brainstorm yes, so if you were going to bring that up if you're going to bring something like that up um how might you could we have a couple ideas about how did how would you how can you say that if you were like having a drink before the turkey and wanted to bring it up don't look at me way there are also a lot of people watching as well and southern and because it's the holiday season doesn't mean it has to be for those three to five hours around the holidays, that could be how they might true talk to him are set up we're over the next couple of months where we might be thinking more of family than we do normally. Well, yeah, do you have e everyone watching this is participating and we're all sitting here with these binders? I mean that's kind of a natural opener in the next weeks, a couple of months, you know, I just went through this court with this amazing woman chanel and we were actually talking about p always and I no doubt this might be sensitive because of the circumstances, but I don't know where your pio is r and I'm trying to get mine together, I just like to have everything one spot yeah, I mean yeah that's that's going exactly so you could say well gee you know I was going through my papers and I'm trying to be organized andi I just realized I don't think I have all your papers I think I could get tha mme could I get one from you I I don't think I know where they are oh well I don't know well you know every you know we're s oh they're so easy to lose I mean I'm wondering if we could figure out a time to do maybe another said if you can't find them what do you think about that I don't I don't really know where to get him I don't really know what it is you know what happen if I help you find them because you know I think I would feel a lot better and a lot more relaxed if I just had everything in one place and I'm realizing it's keeping me up at night so I just like to get this organized so I feel like I have my life a little under control uh well I don't have time to do that I've got the grass to mow and then there's the basement that I need to reorganize and you know there's a lot of the shovel the walk is I'm not really sure I hear when I could do that with you I mean sure it's important and all but it just doesn't seem like you know there's a lot of time for that to happen it might take too long. Oh, ok. Well, you know what? What if I made it really simple? Well, that would that help and then we can we could try because I I appreciate you know they're thinking about thes it's you know, it does seem awkward but you know what? It would really help me if you do it so I would really appreciate it well, if it makes you feel better you know what? Thank you. It would make me feel better. Okay? We're channeling my inner midwestern right now so you know, you know what? S so you know what when I'm coming by to drop that stuff off your house next weekend what if what could we spend ten minutes yeah, we could do that I think we could get it. I think we could do it in ten minutes. I don't think it would take that. I don't think it took a long time I'll bring everything ok, ok. And then after ten minutes you can stop me and wherever we are in ten minutes that's what? Well, what that will do okay, okay. Song is a real drag on and on yeah, ok, ok and I'll bring some of those chocolates you really like the perfect question what do you think about bringing siblings in I'm discussing with your civilly and then doing it as a team you think that would be more complicated depending on your siblings or do you think it would be helpful you need to bring the siblings into like going to your brother and saying we need to go too dad with this let's go together because you are do you think that's more intimidating well uh let's say yeah anybody have a sibling that they want would would bind using as an example here I'm so going oh yeah what's yourself you for if your sibling if you're going to talk to your day out about this just doing the power of attorney let's just to use this example like do you think your sibling would be really would be helpful neutral not helpful probably helpful helpful she has privacy I tie on issue oh ok eso fue convention to her so we should really do this she would be like great, right? Yeah okay uh so let's he could we how would you could we think about a way to set her up help her you know, set her up to be on the same page is you you know what? Can I try something out? So I said so ring ring I'm calling you blah blah blah we're talking about our facebook pages and then you know, I am realizing that dad does not have power of attorney for medical stuff, and I feel like it would be really helpful for him to have one, so I'm going toe mention it. I think if he asks you about it, would you support that? Could you just, uh, reinforce that it's a good idea, so maybe we can each have a little conversation with him. What do you think? Yes. Do you want to be there when we talk about it, or do is it ok if I'd go ahead? Because if you want to be there, we can do it at the time when they were there together, but otherwise I could just do it and tell you, um, um, I being my sister, so what do you think she'd say if you if you asked her if she wanted to be there or if you could just handle it on your own? I think maybe she say, yeah, I'll mention it, and then, you know, see how it goes, get back to you, and then they weaken going together, I could see what you're I think what I'm trying to suggest is you could talk to your sister and talk about how do you guys want to set it up and give her the opportunity to kind of be in on the main in the main event, if you're if you think she's going to be helpful because she'd probably appreciate that knowing because if she gets a call from your dad, this is who he was talking about, this power of attorney thing. And I think it must be because he's done because I keep, you know, I'm a gagner and she'll go no, no, no. He just wants to get his papers, right, right. She she could support you should go out. No, no, no. He just wants to get his paper is in order. You know, everyone says it's a good idea. I think it's a good idea to so I think you guys should just spend ten minutes and do it right, and they come back to you and go. Well, I guess I should do it right. Where is this she's? Unprepared. And she goes well, what's he thinking about and they have this conversation about do you like what's? He thinking about that's not gonna help you, right? Because you just want to set up the momento so that it'll that it'll help and they will just reinforce that it's a good idea. And you're just doing it because it's a good thing.