Why Your Doctor Should Know About Your Bucket List
This essay was originally published in the New York Times.
A bucket list is an itemized list of goals people want to accomplish before they “kick the bucket” — or die. Making a bucket list allows us to reflect on our values and goals and identify important milestones and experiences that we want to have in our lifetime.
In my experience as an internist, geriatrics and palliative care doctor, most patients have a bucket list. Some give it a lot of thought, while others have a nebulous mental checklist of items.
I routinely ask my patients about their bucket lists; I started doing this to forge a personal connection and get a quick glimpse into what matters most to each of them. The responses were fascinating and revealed hidden dimensions of their personalities. For example, one patient wanted to sky-dive on her 80th birthday. When I pointed out that it might be a tad risky given her hypertension, diabetes and osteoarthritis, she shrugged.
“Don’t worry, Doc,” she said. “If I die sky diving, I’ll be sure to take my diseases with me. Besides, the instructors are very handsome, so not a bad way to go at all.”
Other patients were less venturesome and talked about the desire to travel or organize an extended family reunion. A recovered alcoholic, who had been sober for decades, grinned wickedly saying that he wanted to “down a jumbo martini in a long gulp one last time.”
I understood two things in eliciting bucket lists. First, knowing patients’ bucket lists is a great way to get them to adopt healthy behaviors. For example, I found that saying, “I don’t think your half marathon is happening anytime soon if you don’t quit smoking” got my patient’s attention much faster than making obvious and boring statements like, “Smoking is bad for you.” Second — and most important — knowing my patients’ bucket list goals has prevented me from implementing medical interventions that subvert them.
That was the case with a patient of mine who had gallbladder cancer. As cancers go, this is a pretty nasty one. It is often silent until late in the game, when people develop itching and jaundice (yellow pigmentation of skin), as did my patient. We ran numerous tests in the next few days and determined that his cancer was inoperable, and that he might find some benefit from radiation treatments and chemotherapy.
I met with him and went over what his treatments would entail: daily radiation appointments for several weeks and chemotherapy. Did he have things he wanted to accomplish in the time he had left? He was quite resigned to being tethered to the hospital for the weeks to come.
“Always wanted to take my family to Maui — could never afford to go before,” he said. “They already made my radiation appointments. I can go next year, right?” I took one good look at him, and it was clear that he was going to be fading fast. He had no idea how little time he had left or how the radiation and chemotherapy would deplete his meager energy reserves. He would be lucky to get up from bed, let alone get on a flight bound to Hawaii following the treatments. So I told him the unvarnished truth as gently as I could.
As is often the case, he was unsurprised. “What are my options?” he asked.
“You could go to Maui, while you still can,” I told him. “Start the cancer treatments as soon as you return.”
He returned two weeks later beaming like a jack-o’-lantern and brought back the largest tin of macadamia nuts that I had ever seen. If I had not asked about his bucket list, he would have stoically undergone the radiation and chemotherapy, and the Maui trip would have remained a sunny fantasy.
What goes on a bucket list?
In a study published today in the Journal of Palliative Medicine, we asked 3,056 people across the United States and found that nine out of 10 had a bucket list. Participants who said that faith, religion or spirituality were unimportant to them were the least likely to have a bucket list. We also discovered six common themes.
The desire to travel, within the nation or internationally, was the most common bucket list item, followed by the desire to accomplish a personal goal (“drive a Porsche”; “run a marathon”).
One patient wanted to design and build a formal dining room as a gift for his wife, despite his multiple medical problems and chronic pain. He accomplished his goal and built the 12-by-12-foot room by himself in time for their annual family Christmas dinner.
Achieving specific life milestones (“I want to reach our 60th wedding anniversary”), spending quality time with friends and family, and achieving financial stability (“pay off bills”; “be debt-free by age 45”) were next on the list.
The desire to do a daring activity (“Run with the bulls”) was the sixth theme, with young people (26 years of age or less) exponentially more likely to report this desire than older people.
Many — especially those who are not in perfect health — may underestimate the extensive coordination required to make their bucket list wishes possible.
One in four Americans will live with chronic illness like heart disease, cancer or dementia in the last decade of life. Most will undergo numerous medical treatments and procedures in the many years before death.
Your doctor, unaware of your life goals and bucket-list desires, will recommend treatments to you in a vacuum. Some of these treatments could get in the way of your life goals, and you may unknowingly embark upon them without realizing the major impact on your life.
Next time you see your primary care provider, be sure to discuss your current bucket list and ask about the potential impact of proposed treatments on your life goals. Your doctor may even be willing to record your list wishes in your medical record.
Your list is likely to change over the years. As you review and update your bucket list annually (perhaps on your birthday), be sure to inform your doctors and your family.
If you clearly voice your wishes, your doctors should do everything in their power to make sure their treatments do not prevent you from living your life. But if they don’t know what your goals are they cannot help you reach them.
And if you are reading this while you are in good health, you might consider checking some items off your bucket list before it’s too late. That trip to Alaska you’ve always dreamed of will be much more manageable if you can go when you don’t need a wheelchair and an oxygen tank.