February 12, 2021 • 48 mins
There is a BIG difference between End Of Life Planning and Serious Illness Planning.
If you think estate planning is getting your wills and powers of attorney or healthcare directives set up for taking care of things when you die or are about to die, you might be making a big mistake.
If you end up in an ER, the doctors aren't going to look at any end of life planning you might have in place if they think they can still save your life. This requires a whole different way of thinking about planning for serious medical illnesses.
On the show today I speak with critical care physician, Dr. Daren Heyland, who is going to give us a look behind the scenes at what really happens when people and their loved ones are making decisions about their medical care when they are seriously ill, or terminal. We’ve talked a bit about estate planning on the podcast before, and my guest recently attended a financial planning seminar where the positioning of how and when certain parts of an estate plan come into place could have used some fine tuning. He’s also going to discuss an initiative he’s been spearheading, called the Plan Well Guide, Plan Well Guide is a FREE tool to help people learn about medical treatments and prepare them for decision-making during a serious illness, like COVID-19 pneumonia for example.
Find out more here:
Company: https://planwellguide.com/
Twitter: https://twitter.com/darenheyland
Facebook: @planwellguide
Twitter: @plan_well_guide
Instagram: @plan_well_guide
LinkedIn: https://www.linkedin.com/in/daren-heyland-2b674a185/
Guest Bio:
Dr. Daren Heyland is a critical care doctor at Kingston General Hospital and a Professor of Medicine and Epidemiology at Queen’s University. He currently serves as the Director of the Clinical Evaluation Research Unit (CERU) at the Kingston General Hospital. For over a decade he chaired the Canadian Researchers at the End of Life Network (CARENET), which has a focus on developing and evaluating strategies to improve communication and decision-making at the end of life
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:00):
When you present sick to me, as a doctor, at the point
(00:05):
where I have to make decisionsto effectuate whatever you might
have wanted to plan, I don'tknow, if you're dying, I know
that you're sick, I know thatyou could die. But you also
could recover. And as soon as weintroduce that concept of
uncertainty into the decisionmaking, whatever plans you laid
down and your legal documents,and by the way, asked me later
(00:26):
on how sensible it is thatlawyers do health planning, but
anyway, whatever plans you laidthere, under conditions of
certainty, like when I am dying,this is what I want, or this is
what I don't want or when I amin this state, or when there is
no hope, all that language basedon certain conditions being
(00:48):
arrived. Actually, the decisionmaking is upstream. And I have
to make decisions to use or notuse life sustaining treatments.
Well before I know the outcomeis
Preet Banerjee (01:15):
this is mostly money. And I'm your host, Preet
bannerjee. And on the show,Today, I'll be speaking with a
critical care physician, he'sgoing to give us a look behind
the scenes at what reallyhappens when people in their
loved ones are making decisionsabout their medical care when
they are seriously ill, orterminal. And we've talked a bit
(01:35):
about estate planning on thepodcast before and my guest
recently attended a financialplanning seminar where the
positioning of how and whencertain parts of an estate plan
or the estate planningdocuments, how they come into
place. And maybe thatpositioning could have been used
could have used a little bit offine tuning. So we're also going
to discuss that and aninitiative that he's been
(01:58):
spearheading called the planwell, guide. Plan Well,
guide.com is a free tool to helppeople learn about medical
treatments and prepare them fordecision making during a serious
illness. Like COVID-19 pneumoniafor example.
(02:26):
Dr. Darren Hyland is a criticalcare doctor at Kingston General
Hospital and a professor ofmedicine and Epidemiology at
Queen's University. He currentlyserves as the director of the
clinical evaluation researchunit at the Kingston General
Hospital. And for over a decade,he chaired the Canadian
researchers at the end of lifenetwork, which has a focus on
(02:50):
developing and evaluatingstrategies to improve
communication and decisionmaking at the end of life.
Darren, welcome to the show.
Unknown (02:59):
Thanks for having me pretty good to be here.
Preet Banerjee (03:01):
Now, your name was mentioned to me when a
friend of the show Jason watt,who is an instructor at the
Business Career College, met youat a financial planning seminar,
I think and he said that therewas some information being
presented at that seminar thatyou thought maybe wasn't
necessarily being framedproperly, when it comes to
powers of attorney, personaldirectives and end of life
(03:23):
planning. So can you explainwhat was being positioned? what
was being said and what youthink need some clearing up?
Unknown (03:30):
Sure, thanks. And first of all, I gotta say it was a
great financial planning seminarand the presenter, you know, the
speaking to us as physicians andgiving us all this really great
information. But the one piecewhere he's given us a nudge to
get our legal planning documentsdone as well, and in the current
context, was advocating for, youknow, your end of life plans,
(03:55):
get them in place. I felt likewell, wait a minute here, if
you're trying to communicatebest practices, particularly
physicians, I think you shouldbe, you know, with the program
as to what best practices withrespect to end of life plans.
We're trying to change theparadigm a little bit away from
(04:16):
planning for the end of life, toplanning for serious illness. So
let me tell you why. Becausewhen you present sick to me, as
a doctor, at the point where Ihave to make decisions to
effectuate whatever you mighthave wanted to plan, I don't
know if you're dying. I knowthat you're sick, I know that
you could die. But you alsocould recover and as soon as we
(04:38):
introduced that concept ofuncertainty into the decision
making whatever plans you laiddown and use legal documents,
and by the way, asked me lateron how sensible it is that
lawyers do health planning. Butanyway, whatever plans you made
there, under conditions ofcertainty, like when I am dying,
(04:59):
the This is what I want, or thisis what I don't want or when I
am in this state, or when thereis no hope, all that language
based on certain conditionsbeing arrived, actually, the
decision making is upstream. AndI have to make decisions to use
or not use life sustainingtreatments. Well before I know
what the outcome is. And sothat's, that's what I'm about.
(05:23):
That's what I'm trying to changeis move away from this certain
activity that I want to happenat the end of life to Okay,
we've got to talk about seriousillness. And fortunately, COVID
has given us that that platformor that opportunity, where
people are listening, people arehearing that there's a
requirement for us to plan forserious illness.
Preet Banerjee (05:43):
Yeah, and let's, let's talk about this
delineation between end of lifeplanning and serious illness.
Because I think, in manypeople's minds who aren't
exposed to, you know, the ICU,the ers, and they're not in the
health services, they just sortof lump those two together. But
can you explain the differencebetween those two?
Unknown (06:04):
Yeah, and for most Canadians, I would say 95% of
Canadians who have a sicknessthat takes them to hospital,
we're talking about seriousillness. The exceptions would
be, let's say, for example, Ihave advanced cancer, you know,
metastatic disease, I'm on aknown trajectory towards death.
I'm being seen by palliativecare clinicians or perhaps still
(06:27):
oncology. And and I want to planin advance my exit from life
that that is end of lifeplanning, that is still
legitimate. I don't want to sayanything that takes away from
that. But that's not what isuseful when you get sick and go
to the emergency room or seen bya critical care doctor. Where's
that where, you know, you may beshort of breath from your COVID
(06:49):
pneumonia. But at the pointwhere I'm trying to make a
decision, do I do I put you on abreathing machine? Do I send you
to the ICU? Or another verycommon decision in hospital is
do I resuscitate you in theevent that your heart were to
stop? Those are not end of life,those are serious illness there.
And the big key difference iscertainty versus uncertainty,
(07:10):
probability of recovery versus,you know, no probability of
recovery. And
Preet Banerjee (07:15):
part of the reason why there is confusion is
this is not an area where peoplelike to think about, right, we
don't like to contemplate ourmortality. And so sometimes the
first time we're faced withthese decisions is either you
know, maybe an advisor says,hey, there's the things we need
to talk about. Or it's whenyou're in the hospital facing
(07:37):
this. And and it's veryoverwhelming, there's so many
things that you're trying totake in. And so for a lot of
people, this is just notsomething that we tend to think
of in our daily lives. And sothere's this barrier for people
to plan and think ahead from ahealth planning point of view,
as well as from financial andlegal points of view. Can you
(07:59):
share some of the tips or tricksthat you use in your industry to
motivate people to lean intothis, this uncomfortable space
of planning for, you know, thestuff that we don't want to
really consider as we get older?
Because it's not alwayspleasant?
Unknown (08:18):
Well, Preet, I appreciate the question. And I,
at some point, this afternoon,I'd love to flip it back to you
and have you share your tips andtricks, because I think we can
learn from each other. We'reboth, you know, in the financial
planning industry, and in thehealth planning industry, we're
trying to get people to thinkahead and plan ahead. And I know
from national surveys that I'vedone, regarding how much lay
(08:43):
people have engaged in advancedcare planning that only 18% of
Canadians have have done it. Andagain, most of that is done
under the context of planningfor end of life. And so it's not
that useful. And one of thebarriers and and we we did a lot
of qualitative research wherewe're talking to people about
Hey, what do you think about andwhy not and, and, and it's this
(09:07):
issue of death and dying and notwanting to go there. But we'll
have 83 year olds with, youknow, chronic health disease,
but still feeling like, youknow, it's not that time that I
have to think about it, youknow, I I'm still gonna, you
know, I still got a few goodyears. And so what has been
helpful to us is to shift thelanguage away from end of life,
(09:27):
we're not talking about deathand dying. Now, I'm talking
about serious illness, you know,sir, you know, 83 or 23, you
could cross the road right nowand get hit by a truck and, and
end up needing life sustaininginterventions, or at least
decisions about life sustaininginterventions. So the moment we
introduced that concept ofserious illness, preparing for
the future periods when you'reso sick, you can't represent
(09:50):
yourself. You're incapacitatedin some sense, who's going to
represent you and what can youdo to prepare them because my
lived experience has a criticalcare doctors when you come in so
sick, all right, you're not ableto participate in decision
making. So now I'm grabbing afamily member. And I'm forcing
that's a hard word. But I mean,we're constraining them to
(10:12):
participate with us in theselife and death decisions. Can
you imagine how stressful thatis? Can you imagine how
stressful it is on top of thefact that they're already
overwhelmed, because they got aloved one who's critically ill.
And all of that extra stresscould have been prevented by
doing the planning for decisionmaking in advance. So that's
(10:34):
what motivated me as a criticalcare doctor to sort of step out
of the critical care space andsay, you know, what, if I work
upstream with lay people are inprimary care, and help them
realize that at one day, oneday, we're all going to develop
some serious illness and to theextent that we prepare for
ourselves, and are able toverbalize in the way that the
(10:55):
doctor can use that information,better treatment decisions will
be made, I'm more likely to getthe medical care, that's right
for me, I'm more likely to havea better journey in my own
serious illness. And I'veprevented extra stress and
anxiety that my family membermight might experience. And so
(11:16):
really speaking to the benefitsof the thinking ahead and
planning ahead, both for theperson themselves individually,
and the benefits for the familymember plus this, reframing it
around serious illness, not endof life has been so far, what's
been very helpful to us. Doesthat make sense?
Preet Banerjee (11:34):
Absolutely. And I think, you know, when the
challenges from, you know, apersonal finance perspective as
to why, you know, some peoplefind it very difficult to save
for the future, get insurance,and what have you is that these
conditions, in the case of lifeinsurance that you're trying to
mitigate the risk of or notconsuming now, so that you can
(11:55):
consume much more later on inlife. Those conditions are very
abstract. And the more abstractthings are, the less real they
seem, and the less likely we areto plan for that. But I think
now, you know, with COVID-19,especially when people who have
had people around them get ill,and they thought it never would
(12:15):
have thought that this wouldhave happened, there's an
opportunity to at least engagesome more people than normal to
say, Listen, this is why youneed to think about it, because
it may not be COVID-19 for you,but it may be getting hit by a
car that puts you into asituation like this. And I
think, you know, with thepractitioners perspective, in
(12:36):
the financial services, thesethings are all part of kind of
like financial hygiene, thingsthat you're supposed to do and
take care of to prevent paindown the road, if you can. And I
think that's why it'schallenging. But you have this
service that you've set upplainwell guide.com, which looks
like it's something that manypeople in the financial
(12:58):
services, legal industry shouldbe looking at. So can you
explain what this is? What isthe elevator pitch? And why
should people learn more aboutplainwell? guide.com?
Unknown (13:10):
Sure, can I just go back and react though, first to
something that you said pre interms of people have difficulty
thinking ahead and planningahead, because it's so abstract,
and it's so downstream. So it'snot motivating to, you know,
plan for 20, something thatmight happen 25 years in
advance, I just want to speak toone of the other tips that we
(13:31):
find very helpful. And that isspeaking about the short term
benefit of planning ahead, andthis will resonate with you, I'm
sure that there's that peace ofmind, and increased mental
emotional well being that youexperienced today. As you go
through life, knowing that youhave a plan in place. So that's
also important to draw out intothis conversation with with
(13:53):
clients, patients, your clients,my future patients that by
planning today, you'll enjoy agreater peace of mind a greater
mental well being. And frankly,during COVID you know, anything
you can do to increase yourmental well being is a value to
people today. So, so you can'tcontrol the future. You can't
control the pandemic, but youcan control your own life and
(14:14):
what preparations you put inplace and you'll your level of
mental wellness will go uptomorrow when you put these
plans in place today. So that'spart of the elevator speech, I
guess is you know, spend 20minutes today to buy peace of
mind tomorrow, and better healthcare in the future and reduced
(14:35):
distress and anxiety on yourfamily member who has to step in
and represent you. plan wellguide is you know, it's a
virtual or online website wherewe have a lot of content to
explain to you the difference.
The difference between seriousillness decision making, and and
end of life decision making. Andin fact, we don't actually
(14:58):
advocate making decisions inadvance. And we're trying to
move away from that. And this isa big part of my conversation
with the legal professional.
They tend in their documents toput instructions, instructions
that are meant to be for theagent to operationalize. But you
(15:18):
know, why? Why would does itmake sense for you to sort of
have a person make a healthcaredecision in a legal office 25
years, or even two years or eventwo days in advance, when they
have no knowledge of the contextand the possibilities of the
various treatment options andwhat their outcomes might be.
And so the pitch to the legalprofession is stopped doing, you
(15:42):
know, instructional directivesin your planning documents and,
and focus really on the namingand the capacitation of the
agent in Alberta, or thesubstitute decision maker is a
generic term that is applicableacross the country. So if they
would do that, then thecapacitation then comes by, you
(16:04):
know, educating that substitutedecision maker about the
person's values and preferences.
Now, now, here's the pitch tothe healthcare professionals,
because historically, we rely onopen ended questions like Tell
me what's important to you. Andif you're facing someone who's
seriously ill, you know, thosestatements that they utter, are
then get translated in ourbrains into a medical order for
(16:28):
the use or non use of lifesustaining treatments. But what
our research shows is that theopen ended question the whatever
answer is not reproducible, andit results in a lot of medical
error. And you can get 10different physicians, listening
to the same words of a personand interpreting them
(16:50):
differently. And that lack ofreproducibility, lack of
transparency and clinicaldecision making is what results
in a lot of medical errors bymedical errors, I mean, people
getting the wrong treatments,right, usually resulting in
increased suffering. So we canreduce that suffering improves
medical decision making, in theway that we abstract values or
illicit values. You know, withyour clients in the financial
(17:13):
planning industry, I'm sureyou're you're trying to get at
that what's important to you,because that helps you make
planning decisions. It's thesame for us only there's robust
and sophisticated, yet simpleand elegant tools that we use on
plan more guide to how tohighlight what people's values
are, and then a very transparentand innovative way we connect
that to medical treatments. Andso the whole process has
(17:36):
increased reliability, validityand transparency, which leads to
better decision making, whichleads to better patient
outcomes.
Preet Banerjee (17:44):
I want to ask you, if you have had specific
situations that have stayed withyou, where someone has come in
with these contingency planningdocuments, personal directives,
whatever it is, that have beencrafted, you know, maybe 10 or
20 years ago, and they're atodds with the actual situation
(18:06):
that you're facing in the room,what happens in those
situations?
Unknown (18:10):
Yeah, here's the spark for me. Now, I'm going back 20
years, to an incident where Iwas called down to the emergency
room urgently for a gentlemanwho was short of breath in
Extremis, actually, respiratorydistress. So the ER Doc's trying
to manage this patient, andfeeling like a person imminently
(18:30):
needs to be intubated, whichmeans breathing to put down and
put on a breathing machine and,and the person relaxed. So the
machine does all the work, yetthe family come in with the
patient, and they have a livingwell, that basically says, you
know, if there are, you know,when I you know, when there's no
(18:51):
hope, I don't want heroics, justsome some vague language like
that, but the implication thatthe family was communicating is
he wouldn't want machines. Andso I, you know, I got like two
minutes to look at the patientin two minutes to read this
document. And I sit with thefamily and I say, Did, let's
call him john, did john knowwhen he signed this document
(19:13):
that was 12 hours of positivepressure ventilation and a
little bit of medication? Icould probably get him off the
machines again and back out thedoor, as per his usual function.
Did he know that when he signedit? Oh, no, no, no. He didn't
know that. So what do you thinkjohn meant when he signed this
document with theseinstructions? Well, he was
(19:36):
trying to say what when he'sdying, what do you know what,
why why would we put anybody onmachines when they're dying when
we know they're dying? Right?
Well, and I tried to explainWell, that's not the case today.
He's extremely short of breath.
He needs machines, but there's ahigh probability that I can get
them off machines within 24hours and he'll be fine. Oh,
(19:56):
okay. You know, and they werefine. And so then we went And
that was what happened, we haddebated him, he got better, and
he's happy to still be alive.
So. So again, that caseillustrates my key point, right
that planning today, underconditions of certainty, where
there's legal instructions thatthis these are my wishes,
doesn't fit with the clinicalparadigm where I'm seeing sick
(20:18):
people who need decisions madeabout using or not using
licensing treatments, wherethose plans don't connect. And
so we're reframing This is let'splan for serious illness. Let's
not make decisions in advance,but rather, let's prepare for
future decision making. Wherethe doctor really wants to hear
from me, what are my values? Andwhat are my preferences, and
(20:38):
then they put that together inthe moment in the clinical
context, to make the besttreatment decision for me.
Preet Banerjee (20:47):
So on one hand, you're you're kind of making a
plea to the legal community,there's certain things that
maybe you want to stay away frombeing so rigid in planning for
every eventuality from a legalperspective, but what should
they be doing instead of that?
Unknown (21:07):
Yeah, just referring them to plan well guide for
their client to codify theirvalues and preferences, because
the legal language is relevant,where it says, you know, my
agent should make decisionsbased on my values and my
preferences in consultation withmy doctor, period. Okay, so
what's the best way to codifythat? Well, that's what we've
developed with plan well guide.
The output of plan well guide,the output of the planning
(21:32):
process is what we call the deardoctor letter. And it goes
something like this dear doctor,I've been through this planning
exercise, I understand I'm notplanning my death I'm planning
for when I'm sick. And I see youor a colleague, and we have to
make treatment decisions. Andhere are my authentic values.
And here are my informedtreatment preferences. And you
know, I trust that you'll makedecisions with my substitute
(21:55):
decision maker in my bestinterest. So either the person,
you know, if if they're able tospeak, they can recite this,
these statements to their orshow them to the doctor. or more
commonly, when you're,seriously, you're not able to
participate. And so thesubstitute decision maker has a
script that they can follow, youfollow, you know, the documented
(22:17):
values and preferences, andthat'll lead to better treatment
decisions.
Preet Banerjee (22:22):
Yeah. And so in this guide, there's a pamphlet
that I took a look at. Andthere's a couple of things that
I want to talk about to helpsort of demystify what this is
for the listeners out there, theplanners out there. And one of
the things that you talk aboutis the idea of a shared medical
decision. So can you talk aboutwho the inputs are that go into
(22:42):
the shared decision making?
Unknown (22:45):
Sure. And that, and this is actually a really good
point, because, again, it's afundamental paradigm shift from
the old way of doing end of lifeplanning where, you know, either
we as a medical community, orperhaps the legal community,
they position the lay person, asan autonomous decision maker, as
someone that knows all thedetails about health care and
(23:08):
can say I want to beresuscitated, or I don't want to
be resuscitated. And that, thatthat has any legitimacy. And let
me digress and just tell you, Idid a survey of over 400 older
folks on many hospitals inCanada, who had resuscitation
orders on their chart, and wesurveyed them, and we asked them
(23:29):
if they understood anythingabout the processes or the
natures of the treatments thatthey would get if they were
resuscitated. No. We asked themif they understood the outcomes.
What's the probability thatyou'll walk out of here normal
again, if you get resuscitated?
And it only 2% of new knew theright answer to the question.
And so here we have a paradigmwhere we treat people as a
(23:49):
autonomous informed decision.
And we simply ask them well, doyou know if your hardware to
stop, you know, what do you wantus to do? As if that answer has
any validity? And so No, we'retrying to change that paradigm
to share decision making sharedecision making means that you
as a person or your substitute,collaborate equally with a
(24:10):
physician to make the treatmentdecision that's best with you.
So we, we don't put you off inthe corner and say, tick this
box and tell me what you want.
But rather, we have dialogue,and there's information
exchange, there's deliberationand clarification of values. And
the physicians role is toprovide best, best knowledge
about the possible treatments,their risks and benefits and
possible outcomes. And then, youknow, as a physician, when I
(24:34):
when I hear what the values andpreferences are, and I combine
that with my understanding ofthe possible treatments, the
risk benefits, and I can, I canthen offer up you know, a really
solid decision as to what mightbe best for the patient. And
that's, that's the way seriousillness decision making should
(24:54):
look. And so what I need fromthe patient then is for them to
come in They'll articulate theirvalues and preferences in a way
I can connect the dots and makethe best treatment decisions.
Preet Banerjee (25:05):
Yeah, you know, my partner and I, we've talked
casually about, you know, whatwould happen if you, you know,
got into an accident, and theprognosis was dire. And we both
kind of shoot from the hip sortof responses. Yeah, pull the
plug. But it's easy to say thatwhen you're not putting pen to
paper and make any actualdecisions, right. And so I think
(25:26):
this concept of a shared medicaldecision with talks about the
approach based on your values,taking into account that what
situation you actually face atthat time is really unknowable.
And there's so many differentdifferent situations, and you'd
have different courses ofaction, but they would be rooted
in these values that you havedelineated and made clear in
(25:47):
this guide for people to sort ofchoose from, and that can help
inform those decisions. That's amuch better way of thinking of
it, because it It removes thatsense of finality. That, yeah,
I'm making decisions now when Ihave no idea what the situations
are, where they're, thosedecisions are going to be
applied. And so this speaks alittle bit to, there was an
infographic. In your brochure,it talks about the intersection
(26:12):
of quality of life and quantityof life. And these are two
things people need to consideras part of their their planning
for their medical care. Andparticularly what I was drawn to
was that the quality of life onthis chart, there are conditions
that exist where the quality oflife when you're ill, is
(26:34):
characterized as worse thandeath. Can you explain what that
means?
Unknown (26:42):
Yeah, certainly. And let me start by saying that
another key difference with planwill guides approach and end of
life planning is your planningfor serious illness as of today,
okay, this is not for some, ifyou got hit by a car today,
you've got a plan, right? Soyou're not hypothetically
thinking about if I arrive insome certain state, I, you know,
(27:03):
what do you want? What do younot want? So Preet someone as
young and healthy as you,there's no reason why if you got
hit by a car, there's probablyno reason why you wouldn't say,
well, treat me full meal deal, Iwant everything possible.
Because I'm young and unhealthy.
The problem we get into is thatwith some serious illnesses with
(27:24):
prolonged critical illnesses,people suffer a deterioration in
the quality of their life ortheir function. Okay. So for
some people, quality becomesmore important than quantity. So
I'll just make some blanketstatements, young people, it's
all about quality lives and, youknow, enjoy life. For older
(27:45):
people, there's a shift from youknow what, it's not about living
till I'm 100, it's aboutenjoying the quality of my
remaining days. For some people,it's like I'm barely hanging on
at my current level of function,my current level of quality, any
further decrease would beunacceptable to me. And those
are the kind of people who are,if they get serious illness,
(28:07):
they would rather check out thenrun the risk of being kept
alive, which is still apossibility, but being kept
alive in a further reducedhealth state. And so there's
that trade off, right? If I'mpushing to keep you alive at all
costs, it may come at theexpense of quality. In contrast,
if I really focus on justquality, I may not be able to
(28:28):
use the life prolonging measuresavailable to me. So it comes at
the cost of quantity. And soit's really important for me as
a physician, that you answerthat question on plan, well, guy
that says, you know, what typeof person are you the kind of
person that wants us to focus onquality or quantity because, you
know, you can't have both, theycompete, they trade off with
each other. So we I alluded tothe fact that, you know,
(28:51):
sometimes prolonged criticalillness or sometimes given the
nature of the serious illnessthat you've had say that via
traumatic brain injury orcatastrophic injury that severs
your spinal cord, and you're aparaplegic or quadriplegic or
whatever, just some catastrophicinjury, or some prolonged
critical illness takes peopleinto a health state that day,
(29:14):
not me, I'm not passing judgmentin here and saying that's a
health state worse than death.
They're saying that they'resaying things like if I'm left,
you know, in a nursing hometotally dependent on others
unable to interact with peoplethat are familiar with to me, I
would that is worse than death.
So that's really important forus to understand as physicians
(29:37):
are what are those health statesthat you consider to be worse
than death? That's one of thequestions in plan well guide as
well. In the event that in thefuture, you arrive there we will
we know that information andthen we would take that into
consideration when decidingabout your treatment plans.
Preet Banerjee (29:56):
The conversation with Dr. Darren Hyland continues
in June. estimate, if you'reenjoying the show, leaving a
rating and or review on Applepodcasts helps with getting high
quality guests like Dr. Hylanthank you to Allison out of St.
JOHN, New Brunswick for leavinga review and for the nudge for
me to get my butt back to St.
JOHN, to sample the local beers,which I miss and love, also to
(30:19):
Northern BC, who mentioned thatthey completed my financial
advice survey for mydissertation that I'm still
working on. Hope you've donethat soon. Don't hold your
breath. And thank you toeveryone who has already left
ratings and reviews. I really doappreciate it. And now, back to
the conversation with Dr. DarrenHyland.
(30:47):
You know, I don't know if I wantto answer or ask this question.
It'll depend on your answer. Iguess. One of the fears that I
have is if I were to ever becomeincapacitated, I don't think I'm
the only person who's everthought about this. I wonder if
you know, if I was, you know, ina vegetative state, would I be
able to perceive thingshappening around me or be
(31:09):
cognizant, but unable to move orinteract with people who are
unable to signal that I'm inexcruciating pain? And you know,
please pull that plug? Is that?
Is that something that happens?
Like? Again, I don't know if Iwant to know the answer. But
what's the answer?
Unknown (31:26):
Well, unfortunately, the answer is yes, it does
happen. Fortunately, it's veryrare. And as I think of my 20
years in critical care, Iprobably had a handful of
patients who I would consider tobe what we call a locked in
state where they're alive andconscious but not able to
respond, I'm thinking of, andthis actually speaks to the
(31:49):
value of advanced, seriousillness planning. I had a
patient who is a youngLumberjack, and was involved in
an accident where he hurt hisneck. And as a consequence, went
to a chiropractor had a neckadjustment, and don't over
interpret what I'm about to sayhere, because I'm not saying
neck adjustment shouldn'thappen. But just as a
(32:09):
consequence of the constellationof things that happened to this
man in his 40s, he thrombosed,one of the vessels that was at
the feeder to the brainstem. Sobasically, the pathways between
his cortex and the rest of hisbody where we're cut off, so all
he could do is blink, tocommunicate to us. And of
(32:30):
course, he could perceive and,and, you know, integrate, and
think and, and he couldn't talkbecause he couldn't move his
mouth, he couldn't move anyextremities. He's He's in bed.
And he's a very active youngman. And he was super
distressed. And I couldinterpret that because of his
heart rate and his respiratoryrate, and that could either be
distress or pain. So we had tokeep him, you know, sedated, we
(32:53):
had a really important decisionto make about continuance of his
care versus, you know, removethe things that were keeping him
alive and let them go. And canyou imagine how difficult a
decision that would be, but yethis family, because they knew
this individual, because theytalked about it, they knew what
his wish they knew he would nottolerate that, that would be a
health state worse than death tobe in an institution like that.
(33:16):
And so we had to make a harddecision to remove life
sustaining treatments. And hepassed away, you know, quite
quickly after that in peace andcomfort. The point also being
though, that if you know thatthis is a particular health
state that you, you know, youwould not want you document that
and realize that your substitutedecision maker with your
physician will be able to changeyour treatment goals. So if you
(33:39):
sign up for ICU care, I wanteverything done. But you get to
the point where, you know,you've got this health date,
that's not acceptable to you,there can be changes made where
your substitute decision makersnow advocating with your
physician to say, No, no, no, heor she said, This isn't what
they would have wanted. So therecan be a change.
Preet Banerjee (33:57):
Man, I, you know, I don't want to abuse the
time that you're giving to me onthis podcast, but I just I have
to know. So when you've gotsomeone who has been in a
vegetative state for a prolongedperiod of time years, and they
come around, and they theyrecover somewhat. Do they ever
(34:18):
say that? Yeah, I dreamed or Iremember when you came into the
office for your into the roomfor your rounds and stuff like
that? Do they? Do they rememberwhat it's like for you to be you
know, vegetative for years?
Well, I
Unknown (34:31):
can't I can't speak for the years I haven't had patients
like that. What I can say isthat your memories are all
jumbled and gibert and you don'thave a you have a lot of
hallucinations. You have a lotof disorganized thinking. You
have a lot of absent memories,actually, when you emerge from
the coma related to seriousillness. Actually, that's one of
(34:53):
the things people find mostdistressing is six months. 12
months laters they can't piecetogether what really happened
and And they suffer a lot ofpsychological symptoms as a
consequence of that.
Preet Banerjee (35:06):
Okay, I'm gonna stop there, sort of irrational
fear based questions. But let'sgo back to the plan well guide.
So how long did this guide taketo complete? in case people are
wondering Yo, this is like, isthis a week long process to sit
down with people or how long isthis process,
Unknown (35:25):
the online process, on average is 20 to 30 minutes. And
we know that from tracking usersexperience, some take up to an
hour, some take five minutes. Ifyou're sort of a healthcare
professional, and you kind ofknow all the facts, it'll take
you five minutes just to, youknow, and you're done. But if
you're really interested in theinformation that we have,
(35:46):
there's both written and videocontent to show and explain and
talk about, you know how to bestclarify your values. We also
explain the difference betweenICU care, medical care and
comfort care if I may, just fora minute, because I see two very
frequent problems that laypeople get into that results in
medical error. The most frequentis an older person who doesn't
(36:10):
understand what CPR is. And sothey sign up for full
resuscitation including CPR. Wehave a seven minute video
decision aid aroundcardiopulmonary resuscitation,
and they and they see that andthey get informed. And they say,
what, why would I want that? Whywould I sign up for something
like that, that puts me throughthis, and ends up with this kind
(36:32):
of outcome. And so they comeback off CPR as their treatment
decision. On the other end ofthe scale, a very common
scenario is typically older, butnot that old of a person who
signs up for comfort measures.
Comfort measures means that thewhole focus of your medical
treatment is just to alleviatesymptoms. And there, you don't
(36:54):
get curative treatment. So youcould come in with pneumonia and
be short of breath. And you giveoxygen and morphine to treat
your breathlessness but you'renot getting antibiotics for
your, for your pneumonia,because, you know, there's no
plan for cure curative therapyhere. So I look at the 65 year
old across for me who's healthyand well, and he's signed up for
comfort measures. And Iexplained to him that you know,
(37:15):
we come into pneumonia orwhatever your heart attack or
stroke or whatever, you won'tget curative treatment, you'll
just get measures to treat yoursymptoms. You're saying you
don't want a chance at recovery?
Oh, no, no, no, I wasn't sayingthat I and again, they thought
or not these people think thatthey're signing up for their
dying care or when they'redying. This is why why wouldn't
(37:38):
we keep them comfortable, right?
It makes sense when you thinkyou're signing up for your
final, you know, dying episode.
But when you come back to thisparadigm of serious illness
where I don't know if you'redying. And if you're open to an
attempt to curative treatments,you shouldn't be on comfort
care. So we're, we're removingpeople off comfort care,
removing people off orsolicitation and more in the
middle for the most part.
Obviously, those aregeneralizations but the key
(38:00):
point on plan will guide is wewe give the lay consumer a
little more information. So theyhave a sense of what are the
risks and benefits and possibleoutcomes of ICU care medical
care, or comfort care so theycan express an informed
preference.
Preet Banerjee (38:14):
Now, they're the the listenership of this podcast
is quite varied. So there's alot of, you know, consumers in
general. But there's also a lotof people from the financial
planning financial advice,industry, people in the legal
industry who listened to thepodcast. And so what should they
be considering? What is do youhave a message to them about
(38:35):
plan will guide in how they canincorporate that into the advice
that they're giving to people?
Unknown (38:42):
Yeah, and again, this is part of a dialogue that I'm
starting, and I don'tnecessarily have the final
answer to those working in thefinancial planning, planning
industry. But it seems to methat we have an opportunity to
collaborate in a way that willbe a win win for both of us, I'm
offering a free tool thatprovides value to your clients.
So if you're seen as thepurveyor of that that will add
(39:05):
value to your relationship withthe client, you're in a position
where the person is primed,right, you're thinking you're
you've got this person thinkingahead and planning ahead. So
please, why not throw thatmessage in to also think about
their health care, I think it'sa good fit when you're
counseling your clients, notonly about their financial
goals, but that legal piece thatwe've already talked about, or
(39:29):
insurance or critical illnessinsurance or emergency fund,
use, you know, the concept thatsomething bad might happen to
you, you need to prepare forthat period of incapacitation.
And so that's a good fit forthat and all we're asking them
is that they would refer them toplan well guide and I've
developed a number of tools,either paper or electronic that
(39:53):
can be passed to your clients tofacilitate that. That referral.
We've also developed an Ereminder system. Because you
know, you know how it is whenyou know, people know, they need
to plan and they know theythought the forums and do this.
But, you know, in the moment,they may say yes, oh, that's
important, but then life comesright and they get distracted
(40:15):
with 1000 other things. So ifthey sign up for our email
reminder program, then willnudge them every two weeks. Have
you done your planning yet, andwe'll give them a cogent message
in a visual to try and stimulatethem just to keep them on track.
There's,
Preet Banerjee (40:29):
there's a couple of blog posts that you have that
I think are would be veryhelpful to people as well. One
is talking how to prepare forserious illness. And there's
another one that talks about howto work with your lawyers to
effectively plan for your futuremedical care. And so we'll
include those in the show notes.
The the website to visit isplan. Well, guide.com. I think
everyone should check this out.
(40:53):
I looked at it. And it wasreally eye opening a lot of
things there that I had nevereven considered before. It's a
really incredible resource. NowI have two last questions for
you can choose to answer one orboth of them. And this is a
little bit off topic. Well, oneis off topic one isn't. So the
one that isn't off topic is withyour experience working in
(41:15):
critical care. Do you feel likeyour decisions would be
different than the averageperson's would be when it comes
to your serious illness decisionmaking? And the second question
is, there's this commonperspective that doctors are not
very good with money? I'd liketo hear your thoughts on that.
So you can tackle those in anyorder you like?
Unknown (41:38):
I might not touch the last question. But the first
question is, obviously apersonal question. But I would,
you know, I am very much moreconservative in my desire for
aggressive treatment. Not that Idon't love life, don't get me
(41:59):
wrong, I love life. I think I'mmore jaded by the consequences
of prolonged critical illnessand having produced many health
states that are worse thandeath, that if you you shared a
fear with me about you know,health conditions that your My
fear is being in a health stateworse than death, because of my
(42:23):
asking for aggressive medicaltreatments. So for example, my
personal preference for medicaltreatment is I want to go to the
ICU. But if I end up with aheart stoppage, don't don't, you
know, don't resuscitate me, Idon't want to wake up in a brain
impaired state. That's, that'smy limit. So So I but you know,
(42:44):
I think that's a little lessconservative than the average
person who perhaps hasn't beencolored by my clinical
experience or isn't as informedabout the outcome data as I am.
Preet Banerjee (42:56):
So I have a follow up question on that. So
because you have your planningin place for your medical care,
and as you've thought deeplyabout this, do you think you
live your life differentlytoday, like you and adventurous
person? Do you try to takeadvantage of things more than
the average person because youfeel like, I didn't know like,
(43:16):
you feel like you've made thatdecision? You've made peace with
that. And so you've contemplatedseriously the future which, you
know, serious illness death? Doyou feel that you live your life
differently?
Unknown (43:29):
I feel like I live my life to the fullest. I've jumped
out of an airplane four times.
That's what I thought. I'm notafraid of what life has to deal
with. Butbut get back to that peace of
mind though, like I got my plansin place, both financial and
otherwise. And so you know, Ihave a high sense of well being
(43:51):
and, and seek adventure, just toenrich the quality of my life.
Preet Banerjee (43:57):
There you go.
Yeah, I think I saw in yourTwitter profile that the
headshot I think you were hikingsomewhere was at like, Machu
Picchu. Where was that?
Unknown (44:06):
Oh, in the Andes. Yeah.
Preet Banerjee (44:08):
Okay. Very nice.
Yeah. Excellent. All right,Darren, we'll leave it there.
Thank you so much for coming on.
Unknown (44:17):
Preet. Do I have time for one more, take home? You do.
I feel like it and please go topiramal guy.com before him any
more information, what we talkedabout, but I feel like we've
talked about financial tofinancial planners, to lawyers,
and to the general public, butI'm worried a little bit that
younger people listening to thismight say this is not relevant
to me, I have an immortalitysyndrome. I'm gonna live
(44:38):
forever. And that might thatmight be the case. But I want
you to consider one other thingthat you part of a family in a
society where we have we're notwe haven't normalized the
conversation about death, dyingincapacitation, serious illness,
bad things happening to us.
Imagine the impact you wouldhave going to the director Have
(44:58):
a one day when you you've gotyour parents and maybe even your
grandparents at the table. Andyou bring this up as an
experience that, you know, youtook five minutes you went to
the series did this and yourtalk and you just normalize
that, and give them the impetusto go and do that yourself. I
really want to stress theimportance of that just because
that role modeling is powerful.
(45:20):
Your older grandparents, andperhaps even your parents might
need a little coaching or handholding on the web, to navigate
the internet. And so please seeyourself as an ambassador, for
serious illness planning humanisn't as relevant to yourself,
you've got people in yourcircles where it's more
relevant.
Preet Banerjee (45:36):
Yeah, that is a fantastic point. I think that
that role modeling behavior isso important, because that is
that is a particularly tough nutto crack for younger people who
are not just not focused onthose things. They're focused,
they've got so many otherstresses to deal with right now.
But it is important so yeah,everyone should be going to plan
(45:58):
world guide.com I am in a futurepodcast friend of mine, he's a
psychiatrist. And we talk oftenabout physicians and finance
will have that that thatconversation some other time
about physicians and moneybecause it's, it's a very
interesting thing. You know,these are these are type a
people they have, you know,years and years where they're
not making a lot of money goingthrough extended schooling and
(46:21):
residency. And they see theirfriends around them buying stuff
and starting their careers,relatively speaking earlier. And
they're working with people youknow, who are had this clip in
income, they go from very, not alot to quite a bit. And then
they buy a lot of stuff. Andit's fascinating, especially
talking to a psychiatristbecause he's not only a
(46:43):
physician, but he also studiesthe way people think it's, it's
fascinating, so I'm going tohave him on a future podcast.
But Darren, thank you so much.
This has been a fantasticconversation. I really
appreciate it.
Unknown (46:54):
Thanks for having me.
Preet Banerjee (47:15):
If you want more personal finance content, or you
have questions for me or topicsuggestions for the podcast, you
can follow me on Twitter orInstagram. It's the same handle
in both cases at Preet Banerjeealso have two YouTube channels
you can subscribe to my mainchannel covers more personal
finance investing topics thatare global in scope. I also have
(47:37):
a Canadian specific channel aswell. That's it for this
episode. Thank you so much forlistening.
When you present sick to me, as a doctor, at the point
(00:05):
where I have to make decisionsto effectuate whatever you might
have wanted to plan, I don'tknow, if you're dying, I know
that you're sick, I know thatyou could die. But you also
could recover. And as soon as weintroduce that concept of
uncertainty into the decisionmaking, whatever plans you laid
down and your legal documents,and by the way, asked me later
(00:26):
on how sensible it is thatlawyers do health planning, but
anyway, whatever plans you laidthere, under conditions of
certainty, like when I am dying,this is what I want, or this is
what I don't want or when I amin this state, or when there is
no hope, all that language basedon certain conditions being
(00:48):
arrived. Actually, the decisionmaking is upstream. And I have
to make decisions to use or notuse life sustaining treatments.
Well before I know the outcomeis
Preet Banerjee (01:15):
this is mostly money. And I'm your host, Preet
bannerjee. And on the show,Today, I'll be speaking with a
critical care physician, he'sgoing to give us a look behind
the scenes at what reallyhappens when people in their
loved ones are making decisionsabout their medical care when
they are seriously ill, orterminal. And we've talked a bit
(01:35):
about estate planning on thepodcast before and my guest
recently attended a financialplanning seminar where the
positioning of how and whencertain parts of an estate plan
or the estate planningdocuments, how they come into
place. And maybe thatpositioning could have been used
could have used a little bit offine tuning. So we're also going
to discuss that and aninitiative that he's been
(01:58):
spearheading called the planwell, guide. Plan Well,
guide.com is a free tool to helppeople learn about medical
treatments and prepare them fordecision making during a serious
illness. Like COVID-19 pneumoniafor example.
(02:26):
Dr. Darren Hyland is a criticalcare doctor at Kingston General
Hospital and a professor ofmedicine and Epidemiology at
Queen's University. He currentlyserves as the director of the
clinical evaluation researchunit at the Kingston General
Hospital. And for over a decade,he chaired the Canadian
researchers at the end of lifenetwork, which has a focus on
(02:50):
developing and evaluatingstrategies to improve
communication and decisionmaking at the end of life.
Darren, welcome to the show.
Unknown (02:59):
Thanks for having me pretty good to be here.
Preet Banerjee (03:01):
Now, your name was mentioned to me when a
friend of the show Jason watt,who is an instructor at the
Business Career College, met youat a financial planning seminar,
I think and he said that therewas some information being
presented at that seminar thatyou thought maybe wasn't
necessarily being framedproperly, when it comes to
powers of attorney, personaldirectives and end of life
(03:23):
planning. So can you explainwhat was being positioned? what
was being said and what youthink need some clearing up?
Unknown (03:30):
Sure, thanks. And first of all, I gotta say it was a
great financial planning seminarand the presenter, you know, the
speaking to us as physicians andgiving us all this really great
information. But the one piecewhere he's given us a nudge to
get our legal planning documentsdone as well, and in the current
context, was advocating for, youknow, your end of life plans,
(03:55):
get them in place. I felt likewell, wait a minute here, if
you're trying to communicatebest practices, particularly
physicians, I think you shouldbe, you know, with the program
as to what best practices withrespect to end of life plans.
We're trying to change theparadigm a little bit away from
(04:16):
planning for the end of life, toplanning for serious illness. So
let me tell you why. Becausewhen you present sick to me, as
a doctor, at the point where Ihave to make decisions to
effectuate whatever you mighthave wanted to plan, I don't
know if you're dying. I knowthat you're sick, I know that
you could die. But you alsocould recover and as soon as we
(04:38):
introduced that concept ofuncertainty into the decision
making whatever plans you laiddown and use legal documents,
and by the way, asked me lateron how sensible it is that
lawyers do health planning. Butanyway, whatever plans you made
there, under conditions ofcertainty, like when I am dying,
(04:59):
the This is what I want, or thisis what I don't want or when I
am in this state, or when thereis no hope, all that language
based on certain conditionsbeing arrived, actually, the
decision making is upstream. AndI have to make decisions to use
or not use life sustainingtreatments. Well before I know
what the outcome is. And sothat's, that's what I'm about.
(05:23):
That's what I'm trying to changeis move away from this certain
activity that I want to happenat the end of life to Okay,
we've got to talk about seriousillness. And fortunately, COVID
has given us that that platformor that opportunity, where
people are listening, people arehearing that there's a
requirement for us to plan forserious illness.
Preet Banerjee (05:43):
Yeah, and let's, let's talk about this
delineation between end of lifeplanning and serious illness.
Because I think, in manypeople's minds who aren't
exposed to, you know, the ICU,the ers, and they're not in the
health services, they just sortof lump those two together. But
can you explain the differencebetween those two?
Unknown (06:04):
Yeah, and for most Canadians, I would say 95% of
Canadians who have a sicknessthat takes them to hospital,
we're talking about seriousillness. The exceptions would
be, let's say, for example, Ihave advanced cancer, you know,
metastatic disease, I'm on aknown trajectory towards death.
I'm being seen by palliativecare clinicians or perhaps still
(06:27):
oncology. And and I want to planin advance my exit from life
that that is end of lifeplanning, that is still
legitimate. I don't want to sayanything that takes away from
that. But that's not what isuseful when you get sick and go
to the emergency room or seen bya critical care doctor. Where's
that where, you know, you may beshort of breath from your COVID
(06:49):
pneumonia. But at the pointwhere I'm trying to make a
decision, do I do I put you on abreathing machine? Do I send you
to the ICU? Or another verycommon decision in hospital is
do I resuscitate you in theevent that your heart were to
stop? Those are not end of life,those are serious illness there.
And the big key difference iscertainty versus uncertainty,
(07:10):
probability of recovery versus,you know, no probability of
recovery. And
Preet Banerjee (07:15):
part of the reason why there is confusion is
this is not an area where peoplelike to think about, right, we
don't like to contemplate ourmortality. And so sometimes the
first time we're faced withthese decisions is either you
know, maybe an advisor says,hey, there's the things we need
to talk about. Or it's whenyou're in the hospital facing
(07:37):
this. And and it's veryoverwhelming, there's so many
things that you're trying totake in. And so for a lot of
people, this is just notsomething that we tend to think
of in our daily lives. And sothere's this barrier for people
to plan and think ahead from ahealth planning point of view,
as well as from financial andlegal points of view. Can you
(07:59):
share some of the tips or tricksthat you use in your industry to
motivate people to lean intothis, this uncomfortable space
of planning for, you know, thestuff that we don't want to
really consider as we get older?
Because it's not alwayspleasant?
Unknown (08:18):
Well, Preet, I appreciate the question. And I,
at some point, this afternoon,I'd love to flip it back to you
and have you share your tips andtricks, because I think we can
learn from each other. We'reboth, you know, in the financial
planning industry, and in thehealth planning industry, we're
trying to get people to thinkahead and plan ahead. And I know
from national surveys that I'vedone, regarding how much lay
(08:43):
people have engaged in advancedcare planning that only 18% of
Canadians have have done it. Andagain, most of that is done
under the context of planningfor end of life. And so it's not
that useful. And one of thebarriers and and we we did a lot
of qualitative research wherewe're talking to people about
Hey, what do you think about andwhy not and, and, and it's this
(09:07):
issue of death and dying and notwanting to go there. But we'll
have 83 year olds with, youknow, chronic health disease,
but still feeling like, youknow, it's not that time that I
have to think about it, youknow, I I'm still gonna, you
know, I still got a few goodyears. And so what has been
helpful to us is to shift thelanguage away from end of life,
(09:27):
we're not talking about deathand dying. Now, I'm talking
about serious illness, you know,sir, you know, 83 or 23, you
could cross the road right nowand get hit by a truck and, and
end up needing life sustaininginterventions, or at least
decisions about life sustaininginterventions. So the moment we
introduced that concept ofserious illness, preparing for
the future periods when you'reso sick, you can't represent
(09:50):
yourself. You're incapacitatedin some sense, who's going to
represent you and what can youdo to prepare them because my
lived experience has a criticalcare doctors when you come in so
sick, all right, you're not ableto participate in decision
making. So now I'm grabbing afamily member. And I'm forcing
that's a hard word. But I mean,we're constraining them to
(10:12):
participate with us in theselife and death decisions. Can
you imagine how stressful thatis? Can you imagine how
stressful it is on top of thefact that they're already
overwhelmed, because they got aloved one who's critically ill.
And all of that extra stresscould have been prevented by
doing the planning for decisionmaking in advance. So that's
(10:34):
what motivated me as a criticalcare doctor to sort of step out
of the critical care space andsay, you know, what, if I work
upstream with lay people are inprimary care, and help them
realize that at one day, oneday, we're all going to develop
some serious illness and to theextent that we prepare for
ourselves, and are able toverbalize in the way that the
(10:55):
doctor can use that information,better treatment decisions will
be made, I'm more likely to getthe medical care, that's right
for me, I'm more likely to havea better journey in my own
serious illness. And I'veprevented extra stress and
anxiety that my family membermight might experience. And so
(11:16):
really speaking to the benefitsof the thinking ahead and
planning ahead, both for theperson themselves individually,
and the benefits for the familymember plus this, reframing it
around serious illness, not endof life has been so far, what's
been very helpful to us. Doesthat make sense?
Preet Banerjee (11:34):
Absolutely. And I think, you know, when the
challenges from, you know, apersonal finance perspective as
to why, you know, some peoplefind it very difficult to save
for the future, get insurance,and what have you is that these
conditions, in the case of lifeinsurance that you're trying to
mitigate the risk of or notconsuming now, so that you can
(11:55):
consume much more later on inlife. Those conditions are very
abstract. And the more abstractthings are, the less real they
seem, and the less likely we areto plan for that. But I think
now, you know, with COVID-19,especially when people who have
had people around them get ill,and they thought it never would
(12:15):
have thought that this wouldhave happened, there's an
opportunity to at least engagesome more people than normal to
say, Listen, this is why youneed to think about it, because
it may not be COVID-19 for you,but it may be getting hit by a
car that puts you into asituation like this. And I
think, you know, with thepractitioners perspective, in
(12:36):
the financial services, thesethings are all part of kind of
like financial hygiene, thingsthat you're supposed to do and
take care of to prevent paindown the road, if you can. And I
think that's why it'schallenging. But you have this
service that you've set upplainwell guide.com, which looks
like it's something that manypeople in the financial
(12:58):
services, legal industry shouldbe looking at. So can you
explain what this is? What isthe elevator pitch? And why
should people learn more aboutplainwell? guide.com?
Unknown (13:10):
Sure, can I just go back and react though, first to
something that you said pre interms of people have difficulty
thinking ahead and planningahead, because it's so abstract,
and it's so downstream. So it'snot motivating to, you know,
plan for 20, something thatmight happen 25 years in
advance, I just want to speak toone of the other tips that we
(13:31):
find very helpful. And that isspeaking about the short term
benefit of planning ahead, andthis will resonate with you, I'm
sure that there's that peace ofmind, and increased mental
emotional well being that youexperienced today. As you go
through life, knowing that youhave a plan in place. So that's
also important to draw out intothis conversation with with
(13:53):
clients, patients, your clients,my future patients that by
planning today, you'll enjoy agreater peace of mind a greater
mental well being. And frankly,during COVID you know, anything
you can do to increase yourmental well being is a value to
people today. So, so you can'tcontrol the future. You can't
control the pandemic, but youcan control your own life and
(14:14):
what preparations you put inplace and you'll your level of
mental wellness will go uptomorrow when you put these
plans in place today. So that'spart of the elevator speech, I
guess is you know, spend 20minutes today to buy peace of
mind tomorrow, and better healthcare in the future and reduced
(14:35):
distress and anxiety on yourfamily member who has to step in
and represent you. plan wellguide is you know, it's a
virtual or online website wherewe have a lot of content to
explain to you the difference.
The difference between seriousillness decision making, and and
end of life decision making. Andin fact, we don't actually
(14:58):
advocate making decisions inadvance. And we're trying to
move away from that. And this isa big part of my conversation
with the legal professional.
They tend in their documents toput instructions, instructions
that are meant to be for theagent to operationalize. But you
(15:18):
know, why? Why would does itmake sense for you to sort of
have a person make a healthcaredecision in a legal office 25
years, or even two years or eventwo days in advance, when they
have no knowledge of the contextand the possibilities of the
various treatment options andwhat their outcomes might be.
And so the pitch to the legalprofession is stopped doing, you
(15:42):
know, instructional directivesin your planning documents and,
and focus really on the namingand the capacitation of the
agent in Alberta, or thesubstitute decision maker is a
generic term that is applicableacross the country. So if they
would do that, then thecapacitation then comes by, you
(16:04):
know, educating that substitutedecision maker about the
person's values and preferences.
Now, now, here's the pitch tothe healthcare professionals,
because historically, we rely onopen ended questions like Tell
me what's important to you. Andif you're facing someone who's
seriously ill, you know, thosestatements that they utter, are
then get translated in ourbrains into a medical order for
(16:28):
the use or non use of lifesustaining treatments. But what
our research shows is that theopen ended question the whatever
answer is not reproducible, andit results in a lot of medical
error. And you can get 10different physicians, listening
to the same words of a personand interpreting them
(16:50):
differently. And that lack ofreproducibility, lack of
transparency and clinicaldecision making is what results
in a lot of medical errors bymedical errors, I mean, people
getting the wrong treatments,right, usually resulting in
increased suffering. So we canreduce that suffering improves
medical decision making, in theway that we abstract values or
illicit values. You know, withyour clients in the financial
(17:13):
planning industry, I'm sureyou're you're trying to get at
that what's important to you,because that helps you make
planning decisions. It's thesame for us only there's robust
and sophisticated, yet simpleand elegant tools that we use on
plan more guide to how tohighlight what people's values
are, and then a very transparentand innovative way we connect
that to medical treatments. Andso the whole process has
(17:36):
increased reliability, validityand transparency, which leads to
better decision making, whichleads to better patient
outcomes.
Preet Banerjee (17:44):
I want to ask you, if you have had specific
situations that have stayed withyou, where someone has come in
with these contingency planningdocuments, personal directives,
whatever it is, that have beencrafted, you know, maybe 10 or
20 years ago, and they're atodds with the actual situation
(18:06):
that you're facing in the room,what happens in those
situations?
Unknown (18:10):
Yeah, here's the spark for me. Now, I'm going back 20
years, to an incident where Iwas called down to the emergency
room urgently for a gentlemanwho was short of breath in
Extremis, actually, respiratorydistress. So the ER Doc's trying
to manage this patient, andfeeling like a person imminently
(18:30):
needs to be intubated, whichmeans breathing to put down and
put on a breathing machine and,and the person relaxed. So the
machine does all the work, yetthe family come in with the
patient, and they have a livingwell, that basically says, you
know, if there are, you know,when I you know, when there's no
(18:51):
hope, I don't want heroics, justsome some vague language like
that, but the implication thatthe family was communicating is
he wouldn't want machines. Andso I, you know, I got like two
minutes to look at the patientin two minutes to read this
document. And I sit with thefamily and I say, Did, let's
call him john, did john knowwhen he signed this document
(19:13):
that was 12 hours of positivepressure ventilation and a
little bit of medication? Icould probably get him off the
machines again and back out thedoor, as per his usual function.
Did he know that when he signedit? Oh, no, no, no. He didn't
know that. So what do you thinkjohn meant when he signed this
document with theseinstructions? Well, he was
(19:36):
trying to say what when he'sdying, what do you know what,
why why would we put anybody onmachines when they're dying when
we know they're dying? Right?
Well, and I tried to explainWell, that's not the case today.
He's extremely short of breath.
He needs machines, but there's ahigh probability that I can get
them off machines within 24hours and he'll be fine. Oh,
(19:56):
okay. You know, and they werefine. And so then we went And
that was what happened, we haddebated him, he got better, and
he's happy to still be alive.
So. So again, that caseillustrates my key point, right
that planning today, underconditions of certainty, where
there's legal instructions thatthis these are my wishes,
doesn't fit with the clinicalparadigm where I'm seeing sick
(20:18):
people who need decisions madeabout using or not using
licensing treatments, wherethose plans don't connect. And
so we're reframing This is let'splan for serious illness. Let's
not make decisions in advance,but rather, let's prepare for
future decision making. Wherethe doctor really wants to hear
from me, what are my values? Andwhat are my preferences, and
(20:38):
then they put that together inthe moment in the clinical
context, to make the besttreatment decision for me.
Preet Banerjee (20:47):
So on one hand, you're you're kind of making a
plea to the legal community,there's certain things that
maybe you want to stay away frombeing so rigid in planning for
every eventuality from a legalperspective, but what should
they be doing instead of that?
Unknown (21:07):
Yeah, just referring them to plan well guide for
their client to codify theirvalues and preferences, because
the legal language is relevant,where it says, you know, my
agent should make decisionsbased on my values and my
preferences in consultation withmy doctor, period. Okay, so
what's the best way to codifythat? Well, that's what we've
developed with plan well guide.
The output of plan well guide,the output of the planning
(21:32):
process is what we call the deardoctor letter. And it goes
something like this dear doctor,I've been through this planning
exercise, I understand I'm notplanning my death I'm planning
for when I'm sick. And I see youor a colleague, and we have to
make treatment decisions. Andhere are my authentic values.
And here are my informedtreatment preferences. And you
know, I trust that you'll makedecisions with my substitute
(21:55):
decision maker in my bestinterest. So either the person,
you know, if if they're able tospeak, they can recite this,
these statements to their orshow them to the doctor. or more
commonly, when you're,seriously, you're not able to
participate. And so thesubstitute decision maker has a
script that they can follow, youfollow, you know, the documented
(22:17):
values and preferences, andthat'll lead to better treatment
decisions.
Preet Banerjee (22:22):
Yeah. And so in this guide, there's a pamphlet
that I took a look at. Andthere's a couple of things that
I want to talk about to helpsort of demystify what this is
for the listeners out there, theplanners out there. And one of
the things that you talk aboutis the idea of a shared medical
decision. So can you talk aboutwho the inputs are that go into
(22:42):
the shared decision making?
Unknown (22:45):
Sure. And that, and this is actually a really good
point, because, again, it's afundamental paradigm shift from
the old way of doing end of lifeplanning where, you know, either
we as a medical community, orperhaps the legal community,
they position the lay person, asan autonomous decision maker, as
someone that knows all thedetails about health care and
(23:08):
can say I want to beresuscitated, or I don't want to
be resuscitated. And that, thatthat has any legitimacy. And let
me digress and just tell you, Idid a survey of over 400 older
folks on many hospitals inCanada, who had resuscitation
orders on their chart, and wesurveyed them, and we asked them
(23:29):
if they understood anythingabout the processes or the
natures of the treatments thatthey would get if they were
resuscitated. No. We asked themif they understood the outcomes.
What's the probability thatyou'll walk out of here normal
again, if you get resuscitated?
And it only 2% of new knew theright answer to the question.
And so here we have a paradigmwhere we treat people as a
(23:49):
autonomous informed decision.
And we simply ask them well, doyou know if your hardware to
stop, you know, what do you wantus to do? As if that answer has
any validity? And so No, we'retrying to change that paradigm
to share decision making sharedecision making means that you
as a person or your substitute,collaborate equally with a
(24:10):
physician to make the treatmentdecision that's best with you.
So we, we don't put you off inthe corner and say, tick this
box and tell me what you want.
But rather, we have dialogue,and there's information
exchange, there's deliberationand clarification of values. And
the physicians role is toprovide best, best knowledge
about the possible treatments,their risks and benefits and
possible outcomes. And then, youknow, as a physician, when I
(24:34):
when I hear what the values andpreferences are, and I combine
that with my understanding ofthe possible treatments, the
risk benefits, and I can, I canthen offer up you know, a really
solid decision as to what mightbe best for the patient. And
that's, that's the way seriousillness decision making should
(24:54):
look. And so what I need fromthe patient then is for them to
come in They'll articulate theirvalues and preferences in a way
I can connect the dots and makethe best treatment decisions.
Preet Banerjee (25:05):
Yeah, you know, my partner and I, we've talked
casually about, you know, whatwould happen if you, you know,
got into an accident, and theprognosis was dire. And we both
kind of shoot from the hip sortof responses. Yeah, pull the
plug. But it's easy to say thatwhen you're not putting pen to
paper and make any actualdecisions, right. And so I think
(25:26):
this concept of a shared medicaldecision with talks about the
approach based on your values,taking into account that what
situation you actually face atthat time is really unknowable.
And there's so many differentdifferent situations, and you'd
have different courses ofaction, but they would be rooted
in these values that you havedelineated and made clear in
(25:47):
this guide for people to sort ofchoose from, and that can help
inform those decisions. That's amuch better way of thinking of
it, because it It removes thatsense of finality. That, yeah,
I'm making decisions now when Ihave no idea what the situations
are, where they're, thosedecisions are going to be
applied. And so this speaks alittle bit to, there was an
infographic. In your brochure,it talks about the intersection
(26:12):
of quality of life and quantityof life. And these are two
things people need to consideras part of their their planning
for their medical care. Andparticularly what I was drawn to
was that the quality of life onthis chart, there are conditions
that exist where the quality oflife when you're ill, is
(26:34):
characterized as worse thandeath. Can you explain what that
means?
Unknown (26:42):
Yeah, certainly. And let me start by saying that
another key difference with planwill guides approach and end of
life planning is your planningfor serious illness as of today,
okay, this is not for some, ifyou got hit by a car today,
you've got a plan, right? Soyou're not hypothetically
thinking about if I arrive insome certain state, I, you know,
(27:03):
what do you want? What do younot want? So Preet someone as
young and healthy as you,there's no reason why if you got
hit by a car, there's probablyno reason why you wouldn't say,
well, treat me full meal deal, Iwant everything possible.
Because I'm young and unhealthy.
The problem we get into is thatwith some serious illnesses with
(27:24):
prolonged critical illnesses,people suffer a deterioration in
the quality of their life ortheir function. Okay. So for
some people, quality becomesmore important than quantity. So
I'll just make some blanketstatements, young people, it's
all about quality lives and, youknow, enjoy life. For older
(27:45):
people, there's a shift from youknow what, it's not about living
till I'm 100, it's aboutenjoying the quality of my
remaining days. For some people,it's like I'm barely hanging on
at my current level of function,my current level of quality, any
further decrease would beunacceptable to me. And those
are the kind of people who are,if they get serious illness,
(28:07):
they would rather check out thenrun the risk of being kept
alive, which is still apossibility, but being kept
alive in a further reducedhealth state. And so there's
that trade off, right? If I'mpushing to keep you alive at all
costs, it may come at theexpense of quality. In contrast,
if I really focus on justquality, I may not be able to
(28:28):
use the life prolonging measuresavailable to me. So it comes at
the cost of quantity. And soit's really important for me as
a physician, that you answerthat question on plan, well, guy
that says, you know, what typeof person are you the kind of
person that wants us to focus onquality or quantity because, you
know, you can't have both, theycompete, they trade off with
each other. So we I alluded tothe fact that, you know,
(28:51):
sometimes prolonged criticalillness or sometimes given the
nature of the serious illnessthat you've had say that via
traumatic brain injury orcatastrophic injury that severs
your spinal cord, and you're aparaplegic or quadriplegic or
whatever, just some catastrophicinjury, or some prolonged
critical illness takes peopleinto a health state that day,
(29:14):
not me, I'm not passing judgmentin here and saying that's a
health state worse than death.
They're saying that they'resaying things like if I'm left,
you know, in a nursing hometotally dependent on others
unable to interact with peoplethat are familiar with to me, I
would that is worse than death.
So that's really important forus to understand as physicians
(29:37):
are what are those health statesthat you consider to be worse
than death? That's one of thequestions in plan well guide as
well. In the event that in thefuture, you arrive there we will
we know that information andthen we would take that into
consideration when decidingabout your treatment plans.
Preet Banerjee (29:56):
The conversation with Dr. Darren Hyland continues
in June. estimate, if you'reenjoying the show, leaving a
rating and or review on Applepodcasts helps with getting high
quality guests like Dr. Hylanthank you to Allison out of St.
JOHN, New Brunswick for leavinga review and for the nudge for
me to get my butt back to St.
JOHN, to sample the local beers,which I miss and love, also to
(30:19):
Northern BC, who mentioned thatthey completed my financial
advice survey for mydissertation that I'm still
working on. Hope you've donethat soon. Don't hold your
breath. And thank you toeveryone who has already left
ratings and reviews. I really doappreciate it. And now, back to
the conversation with Dr. DarrenHyland.
(30:47):
You know, I don't know if I wantto answer or ask this question.
It'll depend on your answer. Iguess. One of the fears that I
have is if I were to ever becomeincapacitated, I don't think I'm
the only person who's everthought about this. I wonder if
you know, if I was, you know, ina vegetative state, would I be
able to perceive thingshappening around me or be
(31:09):
cognizant, but unable to move orinteract with people who are
unable to signal that I'm inexcruciating pain? And you know,
please pull that plug? Is that?
Is that something that happens?
Like? Again, I don't know if Iwant to know the answer. But
what's the answer?
Unknown (31:26):
Well, unfortunately, the answer is yes, it does
happen. Fortunately, it's veryrare. And as I think of my 20
years in critical care, Iprobably had a handful of
patients who I would consider tobe what we call a locked in
state where they're alive andconscious but not able to
respond, I'm thinking of, andthis actually speaks to the
(31:49):
value of advanced, seriousillness planning. I had a
patient who is a youngLumberjack, and was involved in
an accident where he hurt hisneck. And as a consequence, went
to a chiropractor had a neckadjustment, and don't over
interpret what I'm about to sayhere, because I'm not saying
neck adjustment shouldn'thappen. But just as a
(32:09):
consequence of the constellationof things that happened to this
man in his 40s, he thrombosed,one of the vessels that was at
the feeder to the brainstem. Sobasically, the pathways between
his cortex and the rest of hisbody where we're cut off, so all
he could do is blink, tocommunicate to us. And of
(32:30):
course, he could perceive and,and, you know, integrate, and
think and, and he couldn't talkbecause he couldn't move his
mouth, he couldn't move anyextremities. He's He's in bed.
And he's a very active youngman. And he was super
distressed. And I couldinterpret that because of his
heart rate and his respiratoryrate, and that could either be
distress or pain. So we had tokeep him, you know, sedated, we
(32:53):
had a really important decisionto make about continuance of his
care versus, you know, removethe things that were keeping him
alive and let them go. And canyou imagine how difficult a
decision that would be, but yethis family, because they knew
this individual, because theytalked about it, they knew what
his wish they knew he would nottolerate that, that would be a
health state worse than death tobe in an institution like that.
(33:16):
And so we had to make a harddecision to remove life
sustaining treatments. And hepassed away, you know, quite
quickly after that in peace andcomfort. The point also being
though, that if you know thatthis is a particular health
state that you, you know, youwould not want you document that
and realize that your substitutedecision maker with your
physician will be able to changeyour treatment goals. So if you
(33:39):
sign up for ICU care, I wanteverything done. But you get to
the point where, you know,you've got this health date,
that's not acceptable to you,there can be changes made where
your substitute decision makersnow advocating with your
physician to say, No, no, no, heor she said, This isn't what
they would have wanted. So therecan be a change.
Preet Banerjee (33:57):
Man, I, you know, I don't want to abuse the
time that you're giving to me onthis podcast, but I just I have
to know. So when you've gotsomeone who has been in a
vegetative state for a prolongedperiod of time years, and they
come around, and they theyrecover somewhat. Do they ever
(34:18):
say that? Yeah, I dreamed or Iremember when you came into the
office for your into the roomfor your rounds and stuff like
that? Do they? Do they rememberwhat it's like for you to be you
know, vegetative for years?
Well, I
Unknown (34:31):
can't I can't speak for the years I haven't had patients
like that. What I can say isthat your memories are all
jumbled and gibert and you don'thave a you have a lot of
hallucinations. You have a lotof disorganized thinking. You
have a lot of absent memories,actually, when you emerge from
the coma related to seriousillness. Actually, that's one of
(34:53):
the things people find mostdistressing is six months. 12
months laters they can't piecetogether what really happened
and And they suffer a lot ofpsychological symptoms as a
consequence of that.
Preet Banerjee (35:06):
Okay, I'm gonna stop there, sort of irrational
fear based questions. But let'sgo back to the plan well guide.
So how long did this guide taketo complete? in case people are
wondering Yo, this is like, isthis a week long process to sit
down with people or how long isthis process,
Unknown (35:25):
the online process, on average is 20 to 30 minutes. And
we know that from tracking usersexperience, some take up to an
hour, some take five minutes. Ifyou're sort of a healthcare
professional, and you kind ofknow all the facts, it'll take
you five minutes just to, youknow, and you're done. But if
you're really interested in theinformation that we have,
(35:46):
there's both written and videocontent to show and explain and
talk about, you know how to bestclarify your values. We also
explain the difference betweenICU care, medical care and
comfort care if I may, just fora minute, because I see two very
frequent problems that laypeople get into that results in
medical error. The most frequentis an older person who doesn't
(36:10):
understand what CPR is. And sothey sign up for full
resuscitation including CPR. Wehave a seven minute video
decision aid aroundcardiopulmonary resuscitation,
and they and they see that andthey get informed. And they say,
what, why would I want that? Whywould I sign up for something
like that, that puts me throughthis, and ends up with this kind
(36:32):
of outcome. And so they comeback off CPR as their treatment
decision. On the other end ofthe scale, a very common
scenario is typically older, butnot that old of a person who
signs up for comfort measures.
Comfort measures means that thewhole focus of your medical
treatment is just to alleviatesymptoms. And there, you don't
(36:54):
get curative treatment. So youcould come in with pneumonia and
be short of breath. And you giveoxygen and morphine to treat
your breathlessness but you'renot getting antibiotics for
your, for your pneumonia,because, you know, there's no
plan for cure curative therapyhere. So I look at the 65 year
old across for me who's healthyand well, and he's signed up for
comfort measures. And Iexplained to him that you know,
(37:15):
we come into pneumonia orwhatever your heart attack or
stroke or whatever, you won'tget curative treatment, you'll
just get measures to treat yoursymptoms. You're saying you
don't want a chance at recovery?
Oh, no, no, no, I wasn't sayingthat I and again, they thought
or not these people think thatthey're signing up for their
dying care or when they'redying. This is why why wouldn't
(37:38):
we keep them comfortable, right?
It makes sense when you thinkyou're signing up for your
final, you know, dying episode.
But when you come back to thisparadigm of serious illness
where I don't know if you'redying. And if you're open to an
attempt to curative treatments,you shouldn't be on comfort
care. So we're, we're removingpeople off comfort care,
removing people off orsolicitation and more in the
middle for the most part.
Obviously, those aregeneralizations but the key
(38:00):
point on plan will guide is wewe give the lay consumer a
little more information. So theyhave a sense of what are the
risks and benefits and possibleoutcomes of ICU care medical
care, or comfort care so theycan express an informed
preference.
Preet Banerjee (38:14):
Now, they're the the listenership of this podcast
is quite varied. So there's alot of, you know, consumers in
general. But there's also a lotof people from the financial
planning financial advice,industry, people in the legal
industry who listened to thepodcast. And so what should they
be considering? What is do youhave a message to them about
(38:35):
plan will guide in how they canincorporate that into the advice
that they're giving to people?
Unknown (38:42):
Yeah, and again, this is part of a dialogue that I'm
starting, and I don'tnecessarily have the final
answer to those working in thefinancial planning, planning
industry. But it seems to methat we have an opportunity to
collaborate in a way that willbe a win win for both of us, I'm
offering a free tool thatprovides value to your clients.
So if you're seen as thepurveyor of that that will add
(39:05):
value to your relationship withthe client, you're in a position
where the person is primed,right, you're thinking you're
you've got this person thinkingahead and planning ahead. So
please, why not throw thatmessage in to also think about
their health care, I think it'sa good fit when you're
counseling your clients, notonly about their financial
goals, but that legal piece thatwe've already talked about, or
(39:29):
insurance or critical illnessinsurance or emergency fund,
use, you know, the concept thatsomething bad might happen to
you, you need to prepare forthat period of incapacitation.
And so that's a good fit forthat and all we're asking them
is that they would refer them toplan well guide and I've
developed a number of tools,either paper or electronic that
(39:53):
can be passed to your clients tofacilitate that. That referral.
We've also developed an Ereminder system. Because you
know, you know how it is whenyou know, people know, they need
to plan and they know theythought the forums and do this.
But, you know, in the moment,they may say yes, oh, that's
important, but then life comesright and they get distracted
(40:15):
with 1000 other things. So ifthey sign up for our email
reminder program, then willnudge them every two weeks. Have
you done your planning yet, andwe'll give them a cogent message
in a visual to try and stimulatethem just to keep them on track.
There's,
Preet Banerjee (40:29):
there's a couple of blog posts that you have that
I think are would be veryhelpful to people as well. One
is talking how to prepare forserious illness. And there's
another one that talks about howto work with your lawyers to
effectively plan for your futuremedical care. And so we'll
include those in the show notes.
The the website to visit isplan. Well, guide.com. I think
everyone should check this out.
(40:53):
I looked at it. And it wasreally eye opening a lot of
things there that I had nevereven considered before. It's a
really incredible resource. NowI have two last questions for
you can choose to answer one orboth of them. And this is a
little bit off topic. Well, oneis off topic one isn't. So the
one that isn't off topic is withyour experience working in
(41:15):
critical care. Do you feel likeyour decisions would be
different than the averageperson's would be when it comes
to your serious illness decisionmaking? And the second question
is, there's this commonperspective that doctors are not
very good with money? I'd liketo hear your thoughts on that.
So you can tackle those in anyorder you like?
Unknown (41:38):
I might not touch the last question. But the first
question is, obviously apersonal question. But I would,
you know, I am very much moreconservative in my desire for
aggressive treatment. Not that Idon't love life, don't get me
(41:59):
wrong, I love life. I think I'mmore jaded by the consequences
of prolonged critical illnessand having produced many health
states that are worse thandeath, that if you you shared a
fear with me about you know,health conditions that your My
fear is being in a health stateworse than death, because of my
(42:23):
asking for aggressive medicaltreatments. So for example, my
personal preference for medicaltreatment is I want to go to the
ICU. But if I end up with aheart stoppage, don't don't, you
know, don't resuscitate me, Idon't want to wake up in a brain
impaired state. That's, that'smy limit. So So I but you know,
(42:44):
I think that's a little lessconservative than the average
person who perhaps hasn't beencolored by my clinical
experience or isn't as informedabout the outcome data as I am.
Preet Banerjee (42:56):
So I have a follow up question on that. So
because you have your planningin place for your medical care,
and as you've thought deeplyabout this, do you think you
live your life differentlytoday, like you and adventurous
person? Do you try to takeadvantage of things more than
the average person because youfeel like, I didn't know like,
(43:16):
you feel like you've made thatdecision? You've made peace with
that. And so you've contemplatedseriously the future which, you
know, serious illness death? Doyou feel that you live your life
differently?
Unknown (43:29):
I feel like I live my life to the fullest. I've jumped
out of an airplane four times.
That's what I thought. I'm notafraid of what life has to deal
with. Butbut get back to that peace of
mind though, like I got my plansin place, both financial and
otherwise. And so you know, Ihave a high sense of well being
(43:51):
and, and seek adventure, just toenrich the quality of my life.
Preet Banerjee (43:57):
There you go.
Yeah, I think I saw in yourTwitter profile that the
headshot I think you were hikingsomewhere was at like, Machu
Picchu. Where was that?
Unknown (44:06):
Oh, in the Andes. Yeah.
Preet Banerjee (44:08):
Okay. Very nice.
Yeah. Excellent. All right,Darren, we'll leave it there.
Thank you so much for coming on.
Unknown (44:17):
Preet. Do I have time for one more, take home? You do.
I feel like it and please go topiramal guy.com before him any
more information, what we talkedabout, but I feel like we've
talked about financial tofinancial planners, to lawyers,
and to the general public, butI'm worried a little bit that
younger people listening to thismight say this is not relevant
to me, I have an immortalitysyndrome. I'm gonna live
(44:38):
forever. And that might thatmight be the case. But I want
you to consider one other thingthat you part of a family in a
society where we have we're notwe haven't normalized the
conversation about death, dyingincapacitation, serious illness,
bad things happening to us.
Imagine the impact you wouldhave going to the director Have
(44:58):
a one day when you you've gotyour parents and maybe even your
grandparents at the table. Andyou bring this up as an
experience that, you know, youtook five minutes you went to
the series did this and yourtalk and you just normalize
that, and give them the impetusto go and do that yourself. I
really want to stress theimportance of that just because
that role modeling is powerful.
(45:20):
Your older grandparents, andperhaps even your parents might
need a little coaching or handholding on the web, to navigate
the internet. And so please seeyourself as an ambassador, for
serious illness planning humanisn't as relevant to yourself,
you've got people in yourcircles where it's more
relevant.
Preet Banerjee (45:36):
Yeah, that is a fantastic point. I think that
that role modeling behavior isso important, because that is
that is a particularly tough nutto crack for younger people who
are not just not focused onthose things. They're focused,
they've got so many otherstresses to deal with right now.
But it is important so yeah,everyone should be going to plan
(45:58):
world guide.com I am in a futurepodcast friend of mine, he's a
psychiatrist. And we talk oftenabout physicians and finance
will have that that thatconversation some other time
about physicians and moneybecause it's, it's a very
interesting thing. You know,these are these are type a
people they have, you know,years and years where they're
not making a lot of money goingthrough extended schooling and
(46:21):
residency. And they see theirfriends around them buying stuff
and starting their careers,relatively speaking earlier. And
they're working with people youknow, who are had this clip in
income, they go from very, not alot to quite a bit. And then
they buy a lot of stuff. Andit's fascinating, especially
talking to a psychiatristbecause he's not only a
(46:43):
physician, but he also studiesthe way people think it's, it's
fascinating, so I'm going tohave him on a future podcast.
But Darren, thank you so much.
This has been a fantasticconversation. I really
appreciate it.
Unknown (46:54):
Thanks for having me.
Preet Banerjee (47:15):
If you want more personal finance content, or you
have questions for me or topicsuggestions for the podcast, you
can follow me on Twitter orInstagram. It's the same handle
in both cases at Preet Banerjeealso have two YouTube channels
you can subscribe to my mainchannel covers more personal
finance investing topics thatare global in scope. I also have
(47:37):
a Canadian specific channel aswell. That's it for this
episode. Thank you so much forlistening.
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