Recently, I was given a book by a friend who wrote in it “this book made me think of you and the valuable work you do.” I got started on it almost immediately to see what lay in the pages that made him feel this way. It has only confirmed my passion and desire to help guide families to the right paths for their care choices and quality of life as life has a notso-funny way of throwing more and more curve balls at us as we age. I feel honored and privileged to be asked to consult, advocate, advise and educate families on the many choices they actually have. What astounds me is their unawareness of how many choices their aging parents and loved ones actually have. However, after what my family experienced back in 2007 it is not surprising to me, we knew very little back then also. Had my family been introduced and or educated about the available choices my father could have selected when the hospital announced it was time for his discharge, I guarantee you – he would not have gone to a nursing home as was dictated to us by the medical team in the hospital.

Our medical care system is set up to diagnose, fix and release patients—patients of all kinds suffering from any number of illnesses, chronic disease, injury. The list goes on and on. Doctors are taught to find the answers to our problems and do whatever it takes to fix them and prolong our life. But, there seems to be a very important piece of the care system lacking: the conversations prior to and following treatment. The conversation of how to cope.

I have learned that doctors have three ways of communicating with their patients: The oldest and most traditional is a paternalistic relationship. This type of relationship is where the doctor informs the patient of what they believe to be the best treatment plan for them. They have the knowledge and experience and they make the critical decisions. As quoted by Dr. Atul Gawande in his book Being Mortal, “we tell you only what we believe you need to know.” It is the priestly, doctor-knows-best model, and although often denounced it remains a common mode, especially with the vulnerable patients — the frail, the poor, the elderly and anyone else who tends to do what they are told.

The second type of relationship is termed informative. It is the opposite of paternalistic. We tell you the facts and figures; the rest is up to you. It’s termed a “retail relationship,” the doctor supplies the up-to-date knowledge and skill and the patient is the consumer, there to supply their decision. This has become increasingly more common for doctors and it tends to drive them to become more specialized. They know less and less about their patients but more and more about the science. This way can be very straightforward, doctors supply the facts and patients make their own decisions of which treatment they want based on the facts provided. You have complete autonomy.

However, doctors have found that neither type is what people desire. We want information and control, but we also want guidance. The third type of doctor-patient relationship is called interpretive. Here the doctors’ role is help patients determine what they want. Interpretive doctors ask, “What is most important to you? What are your worries?” Then once they know your answers they tell you about the different treatment options that best help you achieve your priorities. Although I’m not a doctor, I conduct my service in this manner.

Let’s say for example that you have been diagnosed with a chronic disease, one that is treatable, needs periodic managing from your doctor; however there is no cure — you just have to learn how to live with it for the rest of your life. I guess it’s a blessing that it’s treatable right? Of course it is but to what extremes? And, hopefully your caring doctor will take good care of you over the next however many years you live with it and gradually experience the many different crises that come along with it over time.

Do the doctors help you manage your care and existence once you leave their office? Is it their job to assist you in doing so? Is there a professional team of experts who come to your home and help map out your set of circumstances and priorities over the next decade or however long you are expected to remain on this earth and are they going to see to it that your quality of life is full, pain-free and enriched? Probably not, so who then is going to have the conversations with you about how these wishes can be achieved when you are diagnosed and as your disease progresses? Let’s face it, no one wants to talk about it, it’s a very delicate and emotional subject but it is critical if you know what you want your quality of life to be while you are living with your disease.

The conversations should be set around what you want now and what you want for as things progress, what you will need and what has to be done to achieve this. So really it all comes down to choices and hopefully if you have these conversations early enough in your disease with the support of your doctors and family members you will be able to make them yourself. My wish for all seniors or loved ones faced with serious illness is to be part of the process of decision making for as long as they possibly can. My reasoning for starting the conversations early on is that many things change over time that require adjustments, even our loved ones’ wishes. It is a wonderful thing to know what your loved ones want as their life expectancy narrows. Knowing their wants based on their needs can be overwhelming, like walking a tightrope of choices, it takes careful listening and considerations. It’s a process, and time is one of the delicacies of planning around the mystery of decline and sickness. But if handled carefully and with respect of their wishes it will bring you peace — of heart and mind.

Below are some tips and facts that will help us understand that sometimes it’s the small thingsthat can create the biggest changes in our lives:

I have talked about this so many times and every time I meet with a new family “it takes a small village to care for an aging or sick loved one, it’s a team effort and the person who is aged or ill should be the captain.” Each family should form a small team to support the wishes and needs of their loved one. It may start with recognizing their activities of daily living ADL’s (Activities of Daily Living); Feeding, Toileting, Selecting proper attire, Grooming, Maintaining continence, Putting on clothes, Bathing, Walking and transferring (such as moving from bed to wheelchair.) When assistance is provided for your loved ones’ ADL’s it helps lower the risk of a fall. Falls are devastating especially to our elders; they create complete havoc especially if they are already living with an illness.

Did you know that each year over 350,000 Americans fall and break a hip? Of those, 40 percent end up in a nursing home, and 20 percent are never able to walk again. The three primary risk factors for falling are 1) poor balance 2) taking more than four medications and 3) muscle weakness. Elderly people without those risks have a 12-percent chance of falling in a year. Those with all three risk factors have an almost 100-percent chance.

I would like to thank my friend for the thoughtful gift of the book Being Mortal by Atul Gawande, it is a book everyone should read and embrace.