Dr Thomas: Mrs. Jones, your blood pressure is still pretty high so I am going to be starting you on a blood pressure medication. OK?

Cynthia: OK. But, can I ask you a couple of questions about the medicine first?

Dr Thomas: Umm...sure. We’re a little pressed for time, but what questions did you have?

Cynthia: Let’s see… First, what are the risks and benefits, and what other options do I have?

Dr Thomas: Good questions. Well, I’m going to prescribe a water pill. It decreases your blood pressure by having you urinate out extra water. The risks with this medication are that you would have to use the bathroom more often. The benefits are that your blood pressure would likely come down, which will help prevent heart attacks and strokes.

Cynthia: OK, but what I really want to know is how will this blood pressure pill affect my life?

Dr Thomas: Well, you’ll have to take a pill every day. You might have to go to the bathroom more often, and maybe once or twice a year you might have to have your blood checked.

Cynthia: I already have to use the bathroom a lot. I’m afraid if I take this medicine, I won’t be able to leave the house to see my friends. Is there anything else I could take?

Dr Thomas: Well, there is another medication we could try that doesn’t have that side effect.

Cynthia: OK, I think I will go with the second option then.

Dr Thomas: OK. Great. I’ll write a prescription for that.

Dr Garcia: Hi Mr. Jones, Mrs. Jones. It’s good to see you again. How are you, James?

James: Well, the news about my cancer coming back has been very hard on us.

Dr Garcia: I know. I’m so very sorry. But, you know, I’d like to try a different and stronger cancer treatment. Can we talk about that today?

James: Yes. In fact, my wife and I wrote down some questions to ask you about that.

Dr Garcia: Sure. What would you like to know?

James: Well, what's the big picture here? I mean, how long are we talking, doctor? How long do I have to live?

Dr Garcia: Well, everyone is different and I can’t know for sure, but other patients with your type of cancer live about one year.

James: Then let’s talk about treatment.

Dr Garcia: OK

James: I’d like to know about the risk and benefits of this treatment, and what other choices I have. And, most important to me is, what will my life be like during and after the treatment?

Dr Garcia: Those are good questions.

After talking about treatment options...

James: OK, let me see if I understand. The first medicine will make me very sick, but it could help me live maybe a year longer—no guarantees. The second medicine won’t make me as sick, but may help me live maybe only six months more.

Dr Garcia: That’s about right, yes.

James: Well, spending time with my family and grandkids means the world to me. If the first treatment gives me more time but means being in the hospital and not able to see my grandkids—I just wouldn’t want that.

Dr Garcia: I understand.

James: OK, well thanks for the information. I think my wife and I need to go home and think it over.

Dr Garcia: Of course. And, please give me a call if you have any questions.

Dr Thomas: Hi Mr Garcia. Looks like you’re here for a blood pressure check.

Jorge: Right. And this is my niece Vera who’s here as always to help me make my medical decisions.

Dr Thomas: OK. Great. Nice to see you again, Vera. Well, Mr Garcia, your blood pressure is still pretty high so I’m going to start you on blood pressure medication. OK?

Vera: Can I ask you some questions about the medicine first?

Dr Thomas: Uh…sure. We’re a bit pressed for time, but...what kind of questions do you have?

Vera: Can you tell us about the risks and benefits, and what other options are there?

Dr Thomas: Let’s see—I’m going to prescribe a water pill. This decreases blood pressure by having your uncle urinate out extra water. The risks with this medication are that your uncle will have to use the restroom more often...

Jorge: Hmm.

Dr Thomas: ...and, you might have to have your blood checked once or twice a year. The benefits are that your blood pressure will likely go down which will help prevent heart attacks and strokes.

Vera: OK, but I guess my real question is, how will this pill affect my uncle’s life?

Dr Thomas: Well, he’ll have to take a pill every day, he might have to use the bathroom more often, and maybe once or twice a year he'll have to get his blood checked.

Vera: Hmm. Well He’s already told me that he has to go to the bathroom a lot. Uncle, what do you think?

Jorge: I do use the bathroom a lot. I don’t know. I’m afraid if I take this medicine, I’ll be tied to the house. I’ll never see my friends again.

Vera: Is there anything else he could take?

Dr Thomas: Well, there is another medication that we can try that doesn’t have the same side effect.

Vera: The second pill sounds like a better option to me. What do you think?

Jorge: Sure. If I’m tied to the bathroom, I’ll never be able see my friends.

Vera: We'll go with the second option.

Dr Thomas: Sounds good.

Dr Thomas: Hi. It’s good to see you both again. David, we talked about some things at our last visit. And, Mr. Liu, you didn’t want to be part of those discussions.

John: That’s right.

Dr Thomas: Is this what you want today?

John: Yes, if that’s OK, I'll just wait outside. I trust my son David to make all my medical decisions for me.

Dr Thomas: I know it was really hard hearing about your dad’s cancer at our last visit.

David: It was. But I had a feeling it had come back.

Dr Thomas: I want to try a different, stronger cancer treatment.

David: OK. I thought we might be talking about treatment today so I wrote down a few questions. Is that OK?

Dr Thomas: Sure. Go ahead.

David: Well...what’s the big picture here? I mean, I know this isn't good news, but how long are we talking about? How long does my dad have to live?

Dr Thomas: Everybody is different and I don’t know for sure, but patients with your dad’s type of cancer typically live about one year.

David: OK, let’s talk about treatment. I’d like to know what the risks and benefits are of this new treatment. Also, what other choices are there? And how will the treatments affect my dad’s life?

Dr Thomas: Good questions.

David: Let me see if I understand. The first medicine will make my dad very sick, but it could help him live maybe up to a year longer—no guarantees. The second medicine won’t make him as sick, but it may help him live maybe up to six months longer.

Dr Thomas: That’s about right.

David: One thing I do know is that my dad loves spending time with his family, his grandkids. So, maybe the second option is better, I just don't know for sure right now.

Dr Thomas: Do you want to take some time to think about it?

David: Yes. Thank you. I just need to go home and talk it over with the rest of the family.

Dr Thomas: Please call me if you have any questions.