Volume 24, Number 12: December 2023

A Wise & Practical Guide for Patients & their Families

Hope for the Best, Plan for the Rest: 7 Keys for Navigating a Life-Changing Diagnosis
Sammy Winemaker, Hsien Seow
Page Two, 2023
Softcover, 272 pp, $19.95 USD
ISBN: 978-1774582961
Also available: eBook (Kindle), audiobook


Reviewed by Frank Brennan, MD

Much can come from a casual conversation. Several years ago, Canadian palliative medicine professors Sammy Winemaker and Hsien Seow revealed to each other that their ostensibly successful careers as clinicians and researchers left them vaguely unsatisfied. They reflected on what originally drew them to their specialty, and conceded that health professionals and policy makers were the primary audience of their publications and educational work. They realized that their combined experience could be channelled into an initiative for patients and families navigating the experience of a serious life-limiting illness. The first result of that conversation was a podcast, the Waiting Room Revolution; the second is this book, which follows the same seven-step structure.

Hope for the Best, Plan for the Rest begins with the authors’ reflection on the immense difference between a patient and family who know what is likely to unfold with an illness and those who do not. The latter are often unprepared, shocked, and—finally, when all interventions are exhausted—may feel abandoned. The authors frame the book using seven “keys” that allow the patient and their carers to be better informed, more proactive, and prepared for the possibility of both remission and deterioration. Those keys include: taking a broad perspective rather than a singular focus on the day-to-day, understanding your usual reaction to difficult situations, your need for information, the importance of forward planning, and anticipating the effect of this crisis on your family and carers.

Written with a careful eye to plain language and a logical progression of ideas, the book is an accessible, wise, and practical guide. Throughout, the authors address the myriad practical dimensions of this journey—appointments, investigations, treatment regimens, assembling a team of carers, insisting on good information—with the profound emotional dimensions of illness, deterioration, and death.

Each chapter is illustrated by clinical cases that reveal the upheaval felt by patients and runs the spectrum of openness by clinicians about the extent of the patient’s disease and their likely prognosis. In addition to being instructive to lay readers, these stories reinforce to clinicians the importance of spending time with patients and their families, listening carefully, being curious about what is important to them, and seeing the person beyond the disease.

The final two chapters discuss the deteriorating, late phase of an illness and the process of dying. Beautifully written, these closing chapters sensitively and openly describe this period and calmly reassure families about the common myths surrounding death. These chapters could equally sit in a palliative medicine textbook, such is their clarity and practicality.

When a patient is diagnosed with a life-limiting illness, they and their family enter an entirely new and challenging landscape. This book will serve as a useful guide as they traverse this new territory.

Frank Brennan is a palliative care physician and senior lecturer in the Faculty of Medicine at University of New South Wales, Australia. Trained as a lawyer, he has published extensively on the human rights dimensions of pain management and palliative care.

Some Excellent Chapters, but Lacks a Rigorous Edit

The Role of the Family Physician in Older People Care
Jacopo Demurtas, Nicola Veronese (eds)
Springer, 2021
Hardcover, 486 pp
ISBN: 978-3-030-78922-0, $199.99 USD
Also available: softcover, eBook (ePub & pdf)


Reviewed by Romayne Gallagher, MD

The Role of the Family Physician in Older People Care is not a book to be judged by its cover or table of contents. The publisher describes it as part of a series of “state of the art knowledge on the principal diseases encountered in older persons and addresses all aspects of management,” but it is not a clinical book. It is an academic book that deals with the higher-level attitudes, knowledge, and policy that guide care for older adults. It was edited by two Italian physicians, Demurtas from primary care and Veronese from geriatrics, and published by Springer as part of the Practical Issues in Geriatrics series.

This book has some excellent chapters in a section on “Palliative and Supportive Care for Older People.” It includes “Supportive and Palliative Approach to the Older Person,” a well-referenced and written chapter on current thinking around what palliative care knowledge and skill bring to the care of older adults with chronic illness. The following chapter, “Dying at Home,” is an effective argument to give patients the option to die at home. There is a well-written article about spiritual care. These articles are aimed at those who know little about palliative care and thus are helpful for palliative care professionals when we are doing teaching or advocacy. 

Palliative care professionals may find “The Role of the General Practitioner in the Last Developmental Task of the Elder People about Death, Identity, Narratives, and Dignity” by Dr. Ines Testoni interesting. This chapter is written by a social psychologist who studies palliative care, dying, and death and the use of creative arts for understanding and building resilience. The discussion centres on the roots of our culture in which aging and dying have been denied and hidden. Historically, social psychology has taught that individuals change incessantly from birth until death and have developmental tasks that they accomplish in order to grow in complexity and maturity. The final task, which we begin as we age and retire, is knowing how to maintain one’s own identity and despite moments of despair to arrive at the most significant part of self-transcendence: wisdom. However, this task is often not fulfilled, as ageing, illness, and dying are denied because of our culture’s resistance to existential reflection on our mortality. There is a discussion of how the denial of our transience fosters a focus on distractions such as physical perfection, youth, and the ability to control all we can. Because reality is ultimately undeniable, its presence in the face of our denial can lead to depression, loneliness, feelings of abandonment, and the desire to die.

Sadly, much of the book is very challenging to read, perhaps due to poor translation, or English text written or edited by those for whom English is a second (or third, or fourth) language. The book has many run-on sentences that require lots of cognitive work to interpret. Rigorous editing would have reduced repetitions of content, making the book more concise. 

The Role of the Family Physician in Older People Care has a lot of excellent and free content if readability doesn’t drive you into cognitive overload.

Romayne Gallagher is a retired palliative care physician with a keen interest in the treatment of chronic pain in older adults. She founded the palliative care program at the University of British Columbia Hospital.

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