Five Questions


What would a good day look like?”

That’s one of five questions that Atul Gawande thinks people facing a terminal illness should be asked in the early stages of their treatment. 

In his research, Dr. Gawande, a renowned surgeon and best-selling author, has discovered that patients who have these conversations with their family and doctors experience lower levels of anxiety and increased peace of mind in their final days.

So, what are the other four questions?

Gawande also suggests that patients answer…

  • What is your understanding of where you are and of your illness?
  • What are your fears or worries for the future?
  • What are your goals and priorities?
  • What outcomes are unacceptable to you? What are you willing to sacrifice and not?

On the surface, this solution seems pretty easy and straightforward. The patient gets the bad news. The physician explains the diagnosis, reviews potential treatments, and answers any questions that the patient and family might have. The physician then proceeds to ask the five questions, and the patient explains his wishes.

So why isn’t this common practice for near-end-of-life care?

Turns out it’s incredibly hard.

In his first attempt in a role play setting, Dr. Gawande himself was told to talk less and listen more and even called an explain-a-holic.

To no surprise, it’s a drastic change for highly trained medical professionals, who are used to answering questions with facts and data, to switch roles and turn over the decision making to the patient. 

However, one slight change to the delivery could have a major impact on the reach and magnitude of these conversations. As Gawande points out:

This is not just a conversation doctors have; any family can have it, too. It’s not just about the last weeks of life, it’s about the last decade. We are all going to spend a significant part of life with our health getting worse, we’ll get frail and have more illness — and that is a victory. We get an extra 20 years after age 65, the bonus years. What’s acceptable to us and what’s not? That’s the conversation that has to become normal in our country and in the world.

But I’m young and healthy.”

What if we took it a step further and applied this line of questioning to more areas of our lives? And better yet, what if we didn’t wait until our final years to do it?

As it turns out, this approach has also shown impressive results when applied to the planning of our financial lives.

Asking tough questions, assessing tradeoffs, priorities, and fears, and reevaluating our answers over time has a profound impact on the quality of life we experience before we ever reach those final questions from our doctor.

Communication is vital.

Saving for retirement. Planning for your kid’s college. Paying off student loans. Dealing with all of these things while trying to enjoy life today is stressful.

Here’s where communication is key. Communicate with your spouse. Communicate with your kids and parents. Communicate with your team of professionals, which should include your financial planner, attorney, and doctor. Anyone who is a stakeholder in your financial success should be considered. That’s not to say that everyone needs to know everything, but having the right conversations with the right stakeholders will increase your awareness and reduce anxiety.

Simply saying things out loud can be an incredibly powerful way to hold yourself accountable to your real goals and priorities. 

Know your priorities.

Having a clear understanding of your priorities sounds incredibly cliché. But if you really stop and think about it, the process of prioritizing is essentially what real financial planning is all about It’s also an area that most of us fail to clarify in our own lives.

It’s simply much easier to continue down the same path, throwing a few dollars at each financial goal and spending without any intention, rather than saying no to things that aren’t at the top of your list of priorities.

But, guess what? Compromise is good! It just means that you know one thing is more important than the other right now.

It’s also not going to last forever. For example, you might need to prioritize paying off some debt, saving for a short-term goal, or starting a new business over saving for your 3 year old’s college expenses right now.

Having clarity and understanding about today’s pressing issues will enable you to address tomorrow’s priorities, instead of continuing to kick the can down the road and meeting a lot of different goals half way.

Habits matter.

At some point, if things go as Dr. Gawande’s research suggests, we will be asked those five questions by our physician. It will be the hardest, most emotional conversation that most of us ever have.

If we are in the habit of applying that same line of questioning to other areas of our lives, we will only be more prepared to give honest, meaningful responses that accurately express our wishes.

These conversations are tough. Money and death are two of the most avoided topics of conversation for most American families. We can’t afford to let it stay that way. There is simply too much evidence pointing to a higher quality of life if we open up and talk about how we really want to spend our time and money.

So just start. Start small. Open up the dialogue about what you really want out of life. Talk about what should take place if something terrible happens. Talk about where you want to go on the next vacation. Ask yourself if your time and money are both being spent on things that increase your happiness.

A good starting point, no matter your age or health, might even be, What would a good day look like?”

Tagged under Thoughts, a collection of observations on money and life.

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