Cell 2 Soul: The Humane Health Care Blog

God's Grandeur Dawn, January 25, 2020

What Matters in the End

Krista Tippet’s conversation with Atul Gawande

You can listen to this extraordinary interview on the podcast On Being. It lasts about 50 minutes and addresses some of what Gawande addresses in his book “Being Mortal.“

Here are some highlights:

At medicine’s core is the directive that all people deserve the same type of attention by practitioners. Of course, this doesn’t happen. Our biases prevent this.

What does it mean to be a good doctor one for a given patient when you can’t help to fix them? How do you feel and what do you do when you actually have harmed a patient?

With regards to our patients, how can we give them agency to live a good life to the end? That may mean not promoting painful, expensive fruitless therapies.

Medicines goal is really to support a patient’s well-being. This can often mean that the patient will direct her own life.

One can actually ask a patient “What does a good day for you look like? What is the quality of life that you live for? Quality of life should not always be sacrificed for quantity of life.

A 2010 study* from MGH show that those stage four lung cancer patients who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives – and they lived an average of 25% longer. In other words, our decision-making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.

So it’s important to find out what our patients goals are. Susan Block, a palliative care specialist, told him: "A family meeting is a procedure, and it requires no less skill and performing in operation."

A few years ago, I put some notes on Gawande’s book on Google Documents.

*Jennifer S Temel et. al. Early Palliative Care for Patients With Metastatic Non-Small-Cell Lung Cancer. NEJM , 363 (8), 733-42, 2010 Free Full Text