When coffee’s more important than chemo
“My perfect day is an autumn day, with autumn leaves scrunching under my gumboots.” This was one young woman’s deepest wish when The Weekend Sun sought independent response to a patient questionnaire from Tauranga family care physician Dr Andrew Corin.
And, according to the doctor, scrunching autumn leaves was a “perfect” response. “It speaks to a deep desire to connect with nature and find quiet and peaceful places to be reflective.”
“Three hearty meals, a trip to the beach with friends” was a young professional’s idea of a perfect day. “A little dancing or some theatre in the evening, all topped off with some mutually satisfying sex.”
Another perfect score again. “Brilliant, exactly the kind of thing,” says the doctor.
The questionnaire wants to know: “What does a good day look like for you? What are the reasons you are alive? What are you living for?”
Because, as the questionnaire explains, when we get older and have to face the reality of illness, disease and death, doctors aren’t well equipped to consider the wellbeing of patients. “We, as doctors, tend to fight against the process of dying, without understanding what we are fighting for.
“We focus on disease, disease prevention, disease treatment and longevity. Sometimes that focus blinds us to the aspects of life and wellbeing that are important to the patient.”
Knowing the patients’ idea of a “perfect day” and the qualities of life they value the most will impact Dr Corin’s treatment plan. “It will help guide me, as your doctor, to treat you with a goal of wellness in your life, and not just survival.”
The perfect day concept resonated because every last one of Dr Corin’s patients responded positively – some with a simple one line thought, others with deeply considered ideas expressed in essays of several pages.
These are the feelings of some of Dr Corin’s patients. They are published with approval.
“Everything about my horse, spending time with her, caring for her, just being on her back” said a female with anxiety and asthma. “To achieve one task a day,” said a well female. “A sleep in until 9am, then porridge and coffee and reading the paper.” There was also a walk up Mauao, family and ice cream. Families and beaches figured largely in peoples’ perfect days.
“Knowing my children would succeed in being amazing people and doing well in life,” said a woman with allergic rhinitus. “A beach walk. That is my soul food - I feel most at peace when out with nature.” For a well female making a positive difference in someone’s life, this would be the perfect day.
And for a man with metastic lung cancer who obviously has more pressing reasons to ponder a perfect day – “pottering in the garden then a cold beer. Ideal weekend is with the family and then mates for poker night.”
And for an elderly depressed woman? “Things I currently have no time for. My piano playing has been woefully neglected as has listening to my favourite music. Also a cycle ride and early morning swim at the beach.”
And all of this “research” is dutifully recorded on the patient files and is a go-to reference point for consultations.
But what has all this got to do with in-grown toenails, reflux, hypertension, osteoporosis or even life threatening conditions?
Well, Dr Andrew Corin, who’s been building patient relationships in the primary health care business in Tauranga for 20 years, has had a shift in thinking.
“I have become increasingly aware that the way I was trained and the way traditional, contemporary medicine operates, often ends up a bit of a mismatch between what’s important to the patient and what’s important to the clinician.”
And that “mismatch” sometimes means treatment has outcomes for patients that aren’t necessarily what they want.
The traditional model is one of the doctor being in a position of power – the patient does what the doctor tells them. “But now we are in a dynamic relationship where there is partnership. We work as a team. The patient contributes to the consultation as much as the doctor does and I have come to value that collaborative approach.”
Rather than talk of compliance – the patient doing as the doctor tells them – there’s now talk of adherence and concordance. “That means before I tell a patient what to do, I am going to understand what their goals are, and what their understanding of the treatment and outcomes may be. And we as a team, the doctor and the patient, collectively determine the best approach.”
And the “perfect day” concept is the starting point.
That frames up what could be perceived as a morbid view of things, but Dr Corin says it can be very life giving. “If I was going to die tomorrow, next week or next month – what would I want to do with my life right now? What’s important to me?”
A case in point. Patient ‘William’ comes to Dr Corin with a cancer diagnosis and a chemotherapy treatment option. He doesn’t know what to do. What should he do?
Dr Corin’s survey kicks in – how did the patient describe his best day?
William’s documented best day is coffee with his best mates – that’s all he wants from what’s left of his life. But William’s had all sorts of well-meaning pressure – he should draw up a bucket list, have chemotherapy and start ticking the boxes.
“The reality is, if he went down the chemotherapy track, he would probably have a lot of nausea, feel dreadfully unwell, and may have brought himself another two or three months of life, but probably wouldn’t feel like doing what he loved most – coffee and conversation with his mates.”
So the doctor and William agreed chemotherapy wasn’t the best option, but enjoying things important to him was.
Perfect days are quite different to bucket lists.
“I think people think of bucket lists as the outrageously exciting things they wouldn’t normally do – things they should do during the last days of their life. I have had a couple of interesting encounters with patients where the bucket list thing has caused them a great deal of distress.”
And that’s not what he is talking about. “I am actually talking about something that builds joy, flourishing and a sense of fulfilment in the lives of some people – something almost spiritual.” And it could be something as simple as taking grandchildren to the beach and building sandcastles.
The best day thinking has “meaningfully” changed how Dr Corin deals with patients.
“Every time I am having an interaction with a patient, and thinking about treatment options, I catch myself asking ‘is this something that will enhance them doing the things that are important to them, or will it make it more challenging?’. It has really changed how I deal with people.”
Dr Corin has shared his idea with his colleagues at The Doctors practice on Devonport Road. “And they find it intriguing.”
Because the art of medicine – the pastoral and counselling roles as opposed to blood tests, x-rays, pharmaceuticals and dosages – is very important, but hasn’t had the attention it needs.
It is possible Dr Corin will write the recipes for a perfect day into a medical article for the purpose of educating other health practitioners.