Podcast #128 How to Train Your Doctor – Dr. Matthew Tyler

Dr Matthew Tyler is a palliative doctor and champion via social media for having the hard conversations when necessary. He knows that doctors are doing their best, and some excel at breaking difficult news to patients. But communication skills have to be developed over time and with experience, and every patient is unique in their desire for “That Conversation.” So – you have to train your doctor in knowing you! What is a “goals of care conversation”? How do you know what success looks like for you as an individual? How do we begin these conversations with our doctors? I hope that this podcast episode helps you take steps to ensure that you and your doctor are aligned on the important subject of your care.

⁠https://howtotrainyourdoctor.com/⁠

⁠https://www.instagram.com/howtotrainyourdoctor/⁠

⁠https://www.youtube.com/channel/UCj8dh2NwtsW2B1d9SyGhXSg⁠

⁠https://www.linkedin.com/in/matthew-tyler-4848b8206/

Transcript:

Diane Hullet: Hi, I am Diane, and you’re listening to the Best Life Best Death podcast. And today I’ve got a really fun guest, Dr. Matt Tyler. Hi Matt. Hi. Hey, how’s it going? Matt and I kind of found each other on Instagram, and I think he’s got a really interesting angle on the message he’s trying to put out to all of us about what we can do better to take charge of our own healthcare.

So Matt’s work is called How to Train Your Doctor, and gosh, let just tell us a little bit about yourself and then let’s talk about why that, why that phrase is part of your title. 

Dr. Matthew Tyler: Sure, sure. So, I’ve taken a bit of a winding path to get here. Like many folks in the palliative and hospice space, I didn’t intend to go there when I started.

My, my background, truth be told, is in biomedical engineering. I had no intentions on going into medicine. But it was very much interested how the body and the mind worked, mechanically speaking, and then found myself craving more human interaction, so it drifted towards medicine. I actually went to medical school specifically to do psychiatry because again, I found sort of like how the mind and and brain worked was very fascinating.

But then once I was in medical school, I realized I was fascinated how the entire body worked. Not just the mind and brain, but anatomy and physiology and all that stuff. So like any medical student who couldn’t decide what to do, I went into internal medicine to push off the decision a little bit longer.

So I, I finished my internal medicine training and board-certified internal medicine. But very early on in internal medicine training in particular, I realized that by and large we were being trained how to treat diseases first and people second at best. And I was very much interested in, in treating people, and I got quickly bored, underwhelmed, whatever you wanna call it, with the model of.

Here’s what’s wrong with you, here’s what you need to do. Doctor knows best type of model of medicine. And I was very much interested in flipping that towards, you know, what can, what can I as your doctor do for you? And it turned out people have all sorts of thoughts about that. We just typically don’t ask them.

And I found that when I really sat down to talk to people about matter to them, what living meant to them and what they were worried about, what they’re hoping for, all those things. All of a sudden, the medical plan that we had in place didn’t make as much sense as we thought it did. And like as a stroke of total luck, as the gears are turning about this like, sort of realization, I got assigned an elective in palliative medicine as an intern.

And as soon as I jumped into it, I was like, oh, I, this, I, I need to do this. And so I became like the gunner for, for palliative medicine in my intern class from there forward and went on to. Like I said, finished internal medicine residency, went on to do a hospice and palliative medicine fellowship where I got board certified in that too.

And since then, since 2016, I’ve been working primarily in, in palliative medicine though my, my day to, I, I wear a lot of hats these days, but I, I run an inpatient palliative care team, meaning we get consults from folks who are hospitalized to work through plan of care, goals of care, symptom management the typical stuff a palliative doc does.

I do some work with our hospice affiliated team as well. I I run a clinic at our cancer treatment center and do palliative medicine there. And the medical director for our palliative system as well, so oversee operations for a couple other teams as well. So, so 

Diane Hullet: neat. Pause there. I love, I love that the circuitous route kind of took you where you needed to go.

And what, what was it about the palliative team that kind of jumped out at you that you were like, oh, this is more interesting. 

Dr. Matthew Tyler: It was the conversations really, it was kind of just a, a means to an end to have deep conversations with people and, and that’s where they, they were happening in palliative medicine.

That’s where I was expected to sit down with people and talk about, you know, what matters most to them. Whereas in the rest of my training, that was sort of like, yeah, I mean, if you have time, like go for it. But like, we have other stuff to do. You have discharge summaries to write and orders to put in.

You try to fit in those conversations, but it was always sort of like you’re constantly rushing to do that and fitting it in amongst all these other things. Whereas in palliative medicine, like those big conversations were like the work, the, at that front and center. And I just, I wanted to be in the specialty where that was the work and that’s how I just got pulled in so, so magnetically towards palliative medicine.

It’s so 

Diane Hullet: beautiful because this idea that gosh, I mean the medical system, what, where do we even begin, right? There’s so much, there’s so much good and so much power in it, and then there’s so much awry at the same time, and it, I think it almost depends on what you’re interacting with. The, as a layperson, as like a patient, it almost depends what you’re interacting with the medical system for, because if you’re, yeah.

Interacting for like six years ago. I massively broke my leg. Boy was I happy to have, you know, hardcore surgeon and big time recovery and people who could manage that acute situation and patch my leg back together with a bunch of metal. Yeah. But if you’re interacting with a medical system at a more terminal, complicated, less black and white kind of area, it, it can just go so not quite the way you want it.

And I, so I love this how you’ve kind of flipped the conversation and said, how do we train our doctors for the conversation we wanna have? Because I think so many of us think that our doctors. Like, they’ll tell us when it’s time to have a different conversation. You know, the, the medical personnel will let us know.

And you’re kind of thinking as well, they might not, so you might wanna take charge of that yourself. 

Dr. Matthew Tyler: Yeah, yeah, for sure. And I think this is not for like any, any ill will by, by the medical team or, or doctors in general. It’s just, I think we are, we are trained to focus on disease and pathology and when there’s not a disease to fix or treat or pathology to kind of intervene on.

I think a lot of times we just feel helpless and we don’t know, we don’t know what to do. We kind of throw our hands up and it tends to be in the space of serious illness and curable illness where there is a lot of good that we can do. There’s even healing we can do in, in those times, but it requires a different kind of training and one that we don’t typically get in medicine and often where we as people, as patients need to kind of step in and, and take the lead on, on what we need, which.

No, it, it shouldn’t be that way. It, it shouldn’t be that way, but, you know I think you either want to take charge or you, or you don’t. Yeah. 

Diane Hullet: Yeah. What, what do you like, well, first tell us how you came up with this name, how to train your doctor. I. Because it’s kind of a unlike, I don’t know, it’s almost, it’s almost a little edgy or something.

It reminds me of, you mentioned before, like Matt and I were talking before we started recording about the old fabulous movie, how To Train Your Dragon, right? 

Dr. Matthew Tyler: Yeah. I that’s, and that’s where the inspiration came from. I, I, I love that movie and I think depending on how much you wanna nerd out about how to Train your Dragon in, in particular, I mean, the whole premise of this movie, for those who haven’t seen it, is.

It’s like Viking era, and there’s the Vikings and there’s the dragons and their, and their enemies, and they’re constantly fighting one another. And there’s this kid and this dragon who come to be friends and they kind of lead the way to show people a different way to, to coexist with one another. And I think that’s very much what I’m going for with, with, with how to train your dragon is the, the medical system, as we’ve already referenced, is like pits doctors against patients and no one.

No one really wants to operate that way. Like doctors, doctors wanna help you, patients want help. But we have a system where that’s next to impossible to do. It’s, it’s fragmented. We’re, we’re punished for spending more than like 30 seconds of patients. It’s, it’s impossible to do. So this is all about how do we work with a broken system and make it a little bit better to get people care that’s more, more meaningful for them.

And, that’s really what it comes down to. It’s a different kind of training, right? It’s it’s, we’re not really taught how to have these deep conversations. Not, not in, not in a real way. We get maybe like a afternoon webinar about how to break bad news and that sort of the end of it. And we’re certainly not taught to have like real, like deep conversations about terminal illness, serious illness, you know, things that there’s not a straightforward fix for.

I mean, that’s where, there, that’s, there’s a reason there’s a whole fellowship for that. ’cause it’s not something that you can really fit into a medical training. And yet we all die. Like it’s, it’s, we’re all gonna get something at some point and we’re all gonna interface with the medical system probably at some point.

So we kind of gotta fill in those gaps where docs aren’t really necessarily trained to lead you through that. Even if you’re gonna be working with, with those docs. So. My, my hope is to be, you know, creating this resource where people can, you know, get these little snippets or nuggets of wisdom to really take the first step.

Yeah. 

Diane Hullet: What, like why two questions. I mean, why do you feel like it’s helpful for people to feel more agency over their healthcare? Like as you, with your background in psychiatry and the human mind, like why does that matter to feel like we’re in charge or have, again, some agency and, and then secondly, how so how do you begin to do that?

So two huge questions. Yeah. 

Dr. Matthew Tyler: wE’ll totally hammer up everything in the next five minutes here. Yeah, we’ll just put it all here. So again, it’s an interesting phrasing of that question, right? Like why it’s important to, to feel in charge of our, of our healthcare because I, I strongly believe we should all be in charge of our healthcare.

And, and we have to be. I don’t, I don’t know if you’ve talked to Sammy, Weimaker and Xinxiao from Waiting Room Revolution, but they kind of talk about the seven keys to navigating a serious illness, and one of ’em is connecting the dots. And again, healthcare system, it’s a mess. It’s very fragmented.

If you’re not in charge of a coordination of a care, no one, no one really will be. Because we have all these different healthcare systems, these different electronic medical records, they don’t talk to each other very well. Every healthcare professional you interface with, you know, takes charge of some piece of your healthcare, but not the whole thing, and may not even your your primary care doctor if you get a serious illness like, like cancer or heart failure or dementia.

Now you’ve got an oncologist or a cardiologist or neurologist following along and like they own like some of it and the primary care doctor owns some of it, but like who really owns all of it? It gets very, very blurry, very quickly. And so you really have to be the one that is connecting the dots and taking the notes and leading the other docs through what’s going on so they can be the most helpful to you.

So taking charge across providers is important. It’s also important to be in charge with, within an individual provider relationship. Because you, you have to be on the same page with what you’re doing and why you’re doing it. And, and the why is so important, and this is where we, we assume things, we presume things and we’re just not on the same page.

I don’t know how many folks I’ve talked to being treated for cancer and they’re thinking that they’re doing all this for, for cure or at least for a chance of a cure. Whereas the oncologist felt that they were very clear that there was never a chance for cure. We were just trying to buy a little bit of good time, and that was it.

Things that, just, things that we feel have been made explicit just aren’t for all, for all sorts of different reasons. But this is why as, as the person going through all these things, you really gotta take charge and make sure that your and your doc are on the same page with what to expect. What a, what a success looks like for you as an individual versus what a success would look like from a medical point of view.

anD that’s a big piece of it. But the phrasing, the phrasing you asked is why, why is it important to feel in charge? Because I think is a, it’s a more existential thing, right? To be given a serious illness like cancer, like heart failure. You’re, you’re robbed of many things both physically and existentially, that you’re robbed of a.

A future that you thought you would have, you’re, you’re forced to grapple with pieces of your identity, things that you felt defined you, that maybe that’s called into question now and you’re like wondering, who am I with, with this illness? And you’re trying to integrate the illness into your identity.

And that kind of lose out to just being a patient, right? Because everyone wants to be a person, not, not a patient. So feeling in charge is, is very important. And certainly having a plan by being in charge, having a backup plan by being in charge is a big thing, a big deal for a lot of people. And for many, that’s often enough.

But when you’re existentially challenged and kind of grappling for control over something, when the bigger picture’s not totally in your control that can require some deeper work, some real deep reflection about who you are and what matters most to you. And I think having a plan in place kinda sets the groundwork to do that deeper work.

But that, that feeling in charge is really kind of what we’re, we’re all going for. ’cause healthcare, no one really cares about their healthcare, right? They care about their health. And healthcare is sort of a tool to do the things that you want to do. It’s, it’s a, it’s a means to an end, which is, you know, living on our own terms, living to our truest selves.

And we wanna be, we wanna be in charge of our lives and our destinies and our health and healthcare just. It happens to be this annoying system that we deal with to try to achieve all those things. I 

Diane Hullet: think that’s really, really well thought through. And there’s something about like, we wanna be seen, we wanna be heard, we feel like we have, we wanna have some choice.

And, and yet sometimes in the healthcare system, we’re not sure how to like what the first steps even are to do that. So we’re just kind of going along. How do we begin to train our doctor? What are the conversations we can start to have? 

Dr. Matthew Tyler: Yeah. I, I think the biggest thing here is recognizing there’s really not a system in place, in any sort of a universal way in healthcare to, to have these conversations and to talk about what matters most.

So if you are someone who wants your doctor to know what’s important to you, you know what a successful treatment looks like, you, you have to tell them. Like you just, you have to, and that’s really the big piece here, is recognizing that your doctor isn’t necessarily going to have a big picture conversation with you.

When you need it and in the way that you need it. Because again, that just like, it’s not a typical part of training. Right. And and I think, you know, I, I know I’ve ruffled some feathers from some docs who have left comments and saying like, what are you talking about? Like, we’re, we’re trained for this.

And I, I think this is like the, the old, the old struggle of competence versus confidence. And we’re. We’re trained very, very much so to be confident about everything that we do, regardless of if we’re competent to do it. And we certainly get rigorously tested on diagnosis and treatment of diseases.

But in terms of competency for conversations, there’s, there’s less of that. There’s a lot less of that to say. Okay. Like, does your confidence for having this conversation match your competence for doing so? And so challenging that is not always met like super well. But, but it, it’s true. I mean, the numbers don’t lie and there’s plenty of data to back up.

The patients are not having the conversations they want when they want to. It’s not just like me, like like waving my finger at people. Like we’re just, we’re not meeting people where, where they’re at with, with what they need. Describe 

Diane Hullet: in your newsletter this past week, you had this great study that you brought up.

Describe that study and what they found. 

Dr. Matthew Tyler: Yeah, so, so this was in reference to a, a survey the Johnny Hartford Foundation just published this year. And so they asked folks in the US over the age of 50, if any healthcare professional had asked them in the past two years about what, what matters most to them.

And over half these folks said that no one had, no one had talked to them about that. And, you know, it’s, it’s not, it’s not really an isolated thing that the California Healthcare Foundation talked to folks over the age of sixty-five some years ago. About end-of-life conversations. And they, and they ask these folks, you know, do you wanna talk to your doctor about your end-of-life care and your preferences?

And, and over 60% of these folks said they did whereas like 13 or so percent of these folks actually had that conversation. And, and I think to, to kinda play the other side, the other side of the coin here is wire docs not having those conversations. I think certainly the, the training is a piece of this the time is a piece of this, right?

The system stacked against us. The system is not built. To have deep conversations with folks. We have, like, you have a 50 minute time slot and usually the docs in the room are less than that. And now going back to that, that kind of statistic, about 60% of folks over 65 wanna have these conversations.

I mean, the flip side of that is like 30 some odd percent don’t. And every doc I’ve talked to has a story about the time they tried to have a conversation and it blew up in their face. And so. Again, we’re, they’re trying very hard not to jeopardize a relationship and trying to do good where they can without freaking out people or scaring people.

And they don’t, they don’t know just by looking at you like, are you a straight shooter? Or, you know, what kind of information you want and when you want it. And we’re not, we’re not really trained how to ask that or to suss that out either. So, you know, if you are someone who wants everything upfront, like you want the big picture, you want the, the prognosis and all that, like you just have to.

You have to tell ’em, like Doc, like, give it to me. Like give it to me straight. Like what’s, what’s going on? Like, what am I up against? Let ’em know what you need. 

Diane Hullet: Like doctors are juggling a lot and the patient is juggling a lot. They’re not always on the same page for what the juggle is in that moment.

Yeah. And then like you said, time is just against, yeah. My guess is that the, the doctors and nurses who are really good at these conversations. Probably got it. Just through their personality and on the job experience, like it isn’t like they took, they took a particular training that really helped them.

You know, they had a two hour webinar that was the perfect thing. It’s just they’ve got a knack for it and they’ve had some good experiences with patients, which probably builds their competence and confidence for how to kind of say we should, we should talk about some bigger things here, but I can see how the whole thing is kind of.

Stacked against both sides. 

Dr. Matthew Tyler: Yeah. Yeah. You have to, you have to have space for those conversations. You have to, you have to wanna have the conversations with a healthcare provider, and you have to have typically a couple, you know, wins under your belt, where you have the conversation that went well to incentivize that.

But every but beyond that too, like you gotta have the, the training and the coaching and the, and the communication skills to, to back that up as well. So even, even me as an intern realizing I wanted to have these conversations, I also recognized like I, I wasn’t equipped to have these conversations, like with the skillset that I had and, and why palliative care training was so important, why connecting with, with Vital Talk and their communication skills training was so important to me.

’cause you gotta kind of, kind of match the, the will with, with the real hard concrete communication skills training too. The nice part is once you. Kind of jump in there and start having these conversations bit by bit. I mean, they, they don’t have to take very long. A big picture conversation for many folks is just saying, Hey, doc, like this treatment you’re talking about, like, what’s the best case scenario here?

Like, what does a, what does a win look like? Or Hey, doc, like if we do this, like this is what I’m hoping to get outta this treatment. How realistic is that? And, you know, a very important, impactful conversation can take five minutes or less. It’s just to help you get your bearings and understand like what you’re up against and to make sure that you’re, you and your doctor are kind of going for the same thing.

It doesn’t have to be like dissecting like your identity and the meaning of life and living like every, every single visit by any, by any means. How do you 

Diane Hullet: recommend that people begin this? 

Dr. Matthew Tyler: I think it depends first on, you know, what, what’s important to you and having. A moment to yourself to think about what, what is important to you?

Like, how do you see yourself as a person? What are your values? What are your priorities? And that, that can be a very big thing to ask people. Just like, oh, how do you, what are your values? I, I think a helpful exercise is to kind of think about the different domains of your life, like career, family, relationships, hobbies, religion, spirituality.

Take like three or four of those and. Put yourself like one year in the future and you, you run into a friend at the airport and they say, how’s it going? And you say, it’s going great, and here’s why. And they kind of go through like each of those domains saying like, like hobbies wise, like, why, like why was this year so great for you and your hobbies?

Or why was this year so great for you and your family? And like in those answers will be clues kind of pointing you towards what you value and what you prioritize. It may also help you plan your year and kind of set you back up on the right path too. But I think thinking about those things and how your health and healthcare impacts those things again, this kind of goes back to my, I, I have a, what I call goals of care jump starter that starts to get the juices flowing on these conversations.

But I think first it really depends on how much your health and healthcare impacts your life. ’cause if you’re just someone going to your doc once a year for a checkup and like, you don’t really think about it beyond that. These conversations are a lot different than someone with, with stage four cancer who is at the treatment center every week getting their blood drawn, like arms bruised up and down, and just their whole life and schedule built around treatment.

Like that’s a very different situation that requires very different conversations has different trade-offs to care. So you gotta bring that context first, like how much your quality of life really impacts, or, or vice versa, how your healthcare impacts your quality of life. Is a good starting point, and then thinking about why it’s impacting your quality of life will start to unpack what we would call a goals of care conversation.

What is, that’s, 

Diane Hullet: what’s a goals of care conversation? What is that? yEah, 

Dr. Matthew Tyler: it’s kind of an obnoxious phrase, right? Because goals of care really refers to. Whatever your goals for treatment are, like, what are you hoping to accomplish with your medical care? Is it walking again, if you broke your leg is it getting to a wedding if you are living with stage four cancer and kind of peeking through treatment to get to some big life event?

It’s, it’s a very, a very personal thing. And typ and really anyone getting healthcare ought to have goals of care, right? And some, it’s in some camp of like living longer or feeling better in, in the, in the broadest sense of that it’s usually accomplishing one or two or ideally both of those things.

And everyone receiving healthcare has goals of care. It’s tricky because in healthcare and amongst healthcare providers, it’s a very loaded statement, and typically when someone invokes the need to have a goals of care conversation with a patient or their family, it’s because things are going badly, at least from the medical provider’s point of view.

They’re worried about the plan of care being aligned with the goals, and they’re worried that whatever we’re doing here isn’t as helpful as someone thinks it is in somewhere in the, in the sphere of the patient, whether that’s the patient themselves. Person making decisions for them. They’re worried that what we’re doing here is not working.

And that may or may not be true if we haven’t bothered to stop and ask, what are you hoping to achieve here? Maybe it’s aligned, maybe it’s not. But it’s often what we pause and double check. Like, are we, are we going for the same things here? Like, what is, what is your hope here? Right? Like, 

Diane Hullet: are we aligned?

Yes. And, and what are some of the mistakes that we patient laypeople make in those kinds of spaces and conversations Like, is there a way that, what, what can we learn that makes us better at those goals of care conversations? I guess kind of what you said, like honesty with your values. 

Dr. Matthew Tyler: I. Yeah. And, and it is tricky, right?

Because these, you don’t know what you don’t know if you’re, if you’re a late person or a non-medical person. And I know, you know, folks on the other side often will grumble at me saying like, why should I be in charge of this? My doctor be doing this? And like, yes. And it’s not always happening.

And there’s a power gradient there, right? Like, you don’t necessarily want to the, you don’t wanna like annoy people in charge of your healthcare. Like, it’s a, it’s a vulnerable position to be a patient. And you’re pressed for time. There’s, there’s not a lot of time there, but so an any mis any mistake here, I say I put in heavy air quotes ’cause I, I really am not wagging fingers or wanting to put more on the shoulders of people dealing with serious things already.

But things that are helpful to lead these conversations are, are not presuming anything like if you have, if you have clear expectations for your treatment and what you hope to achieve with treatment. Say it out loud. And I get, I get so many eye rolls for this from patients and docs like saying like, what have they told you?

What are you hoping to achieve? And they’re like, well, duh. Like, I wanna live, man. Like, yeah, but like, what do they like, have they, how realistic do they tell you? How much time do we talk about that? Do you want to know like, what is, how much time would this treatment get you? And what would living on this treatment look like in terms of side effects?

Where you would live? Like would you need to move to a nursing home to have the help you need to continue on this treatment pathway? I think that’s really the main thing is when you’re talking to your doc about what this treatment would look like, what the expectations are, really have them encourage ’em to paint a picture for you.

Like, what am I doing? You know, what’s my functionality? Like, where am I living? What kind of help would I need? Really just understanding what does my day to day look like on this pathway. ’cause they don’t always. Paint it in those terms. They’ll maybe give you some progression-free survival statistics, but maybe not tell you like you’re gonna be like super worn out.

Need lots of help, may not be able to keep living at home. The things that people really care about may not come up. So you have to be explicit about. What a successful treatment looks like to you? I can think 

Diane Hullet: of a story of a, a friend who had a relative recently where a situation like that really unfolded with so much difficulty, and part of it was, I think, not quite having these conversations.

So the, the gentleman was found to have a very advanced stage of cancer and he ended up having surgery for that. And then that led to another surgery. And then, oh, it turned out his home was actually three flights up and he wasn’t gonna be able to go back home. Nobody had really talked about that ahead of time.

And then the wife wasn’t really capable of caretaking. And so the whole thing became this giant what do we call it, quagmire of, of incomplete conversations that led to a very complicated end of life. That was sort of ultimately tragic, although at the very, very end, he got into a hospice living situation.

And so that was okay, but that was like the last five days after this complete mess of a couple of months for everybody involved. And it was, I think traumatic and complicated and expensive. And. All these things that I’m not sure would’ve been his first choice or his partner’s first choice had they known where it was headed, but because nobody wanted to look at where it was really headed, they just sort of dove in with, yep, let’s do that surgery.

Oh, another one. Okay, let’s do another one. With no discussion about the impact on this 85-year-old body, it was really painful to watch from a step removed and yet. I think they were just in the weeds, you know, trying to do the best they could. Nobody purposely made bad choices, but the cumulativeness of it was really a difficult situation for everyone involved.

And so I think that’s the kind of thing you’re talking about. I. How do we avoid that? And I love your my goals of care. Jump Starter. This is a free download off Matt’s website. Thank you. And Matt’s website is Howtotrainyourdoctor.com, so you can easily find out more about his resources. Gosh, I, there’s so much more to say.

What, what’s your, what’s your best advice for kind of tackling these large and small conversations? I mean, 

Dr. Matthew Tyler: honestly have, have the conversations. They don’t, they don’t have to be perfect. And just recognize everyone, everyone’s trying their best here on both sides. And, you know, people will, will make mistakes.

But just, just jump in and, and start somewhere. And start by having a conversation with yourself about, you know, what, what does quality of life mean to you? What does living mean to you? And, you know, think to yourself, you know, what, how is my quality of life impacted by my health right now? And. If it’s like not at all, then great.

Like maybe come back to this when it is. And if it is impacted right now, you know, start to think about, you know, how that influences your decision making and just share that with your dog. Just say, Hey, just Doc, I want you to know, like these things are very important to me. If ever like these call into question, I wanna reassess what we’re doing here.

And bring and bring your people into these conversations. So not just your doc, but especially whoever your backup decision maker would be. A,, make sure you have a healthcare power attorney so they have a, a legally appointed backup decision maker. And B,. Don’t wait for a crisis to bring them into the loop.

Like bring them in now. Like if, if they can come to your appointments, like, awesome, like bring them in, make sure they know what’s going on. Not only so they know what’s going on with your health, but also so they know like how you’re thinking about things. ’cause the ideal backup decision maker. Step into your shoes and make decisions as if they were you.

But if you haven’t told ’em how, how you think about things, that’s gonna be really hard to do. So bring them into the loop. Make sure everyone else in your family like knows who, who’s in charge if you’re not, so they’re not hassling them too much ’cause boy, does that happen sometimes. And, those are really, those are really the big things. Just like start the conversation somewhere. 

Diane Hullet: Those are big. Those are huge. I mean, I think, take that to heart. If you’re listening and you don’t have a healthcare proxy named legally, please go do that this week. Yes. Like that’s so, so important. And that’s for any of us who, who can’t speak for ourselves for whatever reason, a car accident, a sudden seizure that.

Throws us into unconsciousness. Like we need, you need to know who that legal person is. And I love what you just said, Matt, that it’s so important that everybody in the family system or the friend system or whatever it is that they know so that that person is supported, not hassled. ’cause I think that is happens more than we care to think and yeah.

You. You want that healthcare proxy person to feel like they’re empowered and supported because they’re making really difficult decisions and you want them to know what your thinking is and have shared that all along. I would also add, if you are a healthcare person and you are beloved person who’s starting to be ill or deep into some illness or fragility, starts to bring this up.

Please don’t shut them down with like, oh no, no, dad, we don’t need to talk about that. Oh, grandma, that’s not a problem. You’re doing so well. I’m sure you’ll live to be 90. Please let them talk and listen because what they’re trying to tell you is really important, and these are vulnerable conversations.

And I think our society want, we just, we’re kind of taught to brush them off and they’re uncomfortable and so don’t go there, but they’re critical and they will come back to be so helpful. You’ll be so glad you had that conversation when the crisis comes, 

Dr. Matthew Tyler: right? Yeah, it is. It is such a gift to know what to do in a crisis that’s, it’s not common, you know, folks get thrown into these situations with no preparation and it’s terrifying ’cause everyone just wants to do right by their loved one.

Conversely, the folks that are sick just wanna know their family’s gonna be okay when, when they’re gone. And having these conversations, preparing people to enter a crisis, but some general sense of direction is, is such, such an amazing gift. 

Diane Hullet: Yeah. Yeah. It really is. And you’re, you’re giving your. Family members and loved ones, kind of peace of mind when they’re having to make these hard choices.

Did mom want a feeding tube? We don’t know. We never talked about it. We have no idea. Gosh, I guess we should probably do that even though the chances of it being helpful are so slim. And I always think it’s important to remember too, that these aggressive interventions, when someone is nearing the end of life.

You know, they, they often, I love Chaplain, Hank Dunn said this on a podcast with me. He said, you know, people think they’re making life and death decisions for family members. It’s often death and death decisions. So what kind of death are you hoping for? Because they, they are coming towards that very quickly.

And what is, what are the goals of care for that moment? Yeah. I, I, 

Dr. Matthew Tyler: I talk about this to, to fellow docs all the time. Being careful not to set up false choices for families. To make it clear that, you know, these, once we get into these very difficult situations where we can’t fix the underlying illness, we do sort of, we feel obligated to offer these things.

’cause docs often connect hope with interventions. They don’t, they don’t know another way to offer hope or to align with families other than to offer some sort of procedure, surgery, medication, even if they really don’t think it’ll help. And when you’re on the other side of that and you’re desperate and scared and you don’t wanna lose your loved one, like, you’ll, like, you’re in survival mode, you’ll say yes to anything.

And unless you prepare for that ahead of time, or unless you’re, if you’re very, very savvy and can tell the doc, like, be straight with me. Like, do you think this will actually help? Do you think, like, what, what will this achieve? And if you’ve got a doc that’s confident enough to say, I mean nothing which is also, you know, not, not a hundred percent of the time where you get such honesty I.

Diane Hullet: Yeah. And I always hope that at those junctures, like what either what family members will ask or what a doctor will offer is it might be time to consider hospice. Yeah. Like as a family member, you can say, gee, is it time to consider hospice? Would that be the most comfortable way to continue to receive medical care, but more about comfort and more about relaxing and more about comfort and longevity.

Whatever that longevity in quotes means. But that can be really different than the aggressive places that we tend to go. 

Dr. Matthew Tyler: Yeah. Which, which ironically in cases like with the feeding tube or, or chemo at the very end of life, and often those things will shorten life. As opposed to picking a more conservative, you know, careful hand feeding or transition to hospice rather than chemo often that will be the pathway that gives you more time and, and better time at that.

Diane Hullet: More quality. Well, Matt, I thank you so much. We, we’ve gotta stop, but you can find out more about Matt’s work at Howtotrainyourdoctor.com. You can find out more about the work I do at bestlifebestdeath.com and I think, you know, you and I have the same goal, which is conversation. 

Dr. Matthew Tyler: Absolutely. Thanks so much for inviting me on here.

This was a really, really fun conversation. Happy to come back anytime. 

Diane Hullet: I, yeah, I feel like we could go a lot of different directions, so we’ll have to think about that when when you publish a book. I think we should talk again. I feel there’s book in 

Dr. Matthew Tyler: this. Thank you. Confidence. 

Diane Hullet: All right. Thanks so much for listening.

Diane Hullet

Diane Hullet

End of Life Doula, Podcaster, and founder of Best Life Best Death.

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