Know what you want: HAVE the tough conversations early.

Is it okay not to investigate and treat somebody when they get sick at home? This is a big scary question for a lot of people. Part of the answer for a Sunshiner is to know what the person wants and doesn’t want, BEFORE they get sick. Are you willing to take a chance of dying at home of something unknown, in order to avoid dying in the hospital of exactly the same thing with a label on it?

Nobody knows how often a Sunshiner’s life is “saved” by a trip to the hospital, but my experience tells me it’s rare. It depends what we mean by “saving a life”. Would living an extra few days count? What about living an extra six months? Is your life saved if you spend the rest of it in the hospital?  How accurate is a family doctor when he makes an educated guess at the home bedside that somebody has had a stroke or a heart attack?  Most of the time, staying home at the end of your life is a more comfortable choice, and I find that hospital investigation and treatment rarely makes any honest difference to what happens to somebody.

I think Sunshiners and their relatives need the rest of us to give them permission to take the risk of staying home if they decide they want to. Your doctors and nurses should use their training and experience to tell you what they think, you should trust them, and then you should decide for yourself.

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 40 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.
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