A change in a personal habit has allowed me more time for reading. I’m really enjoying this change even if some of the books I choose to read are not a “walk in the park.” Being Mortal: Medicine and What Matters in the End by Atul Gawande is a powerful and dark book about the state of medicine in the U.S. It is full of solid research about senior care, in particular, as well as many reflections on Dr. Gawande’s medical practice and personal experiences.
Most of the book paints a very grim picture of the dying process in the U.S. and presents a lot of evidence of the harm that aggressive medical interventions do at the end of one’s life. Dr. Gawande points out repeatedly how these treatments and surgeries do not in fact extend or improve a person’s life. Instead they often have the opposite effect — leading to greater disability and a distancing from what matters most to the individual.
Indeed, this is one of the most profound and helpful aspects of this book. The importance of the values of the patient should be the driver to determine what steps to take next. Rather than using a pre-determined checklist of you have X disease, therefore you will submit to Y and Z test, procedure, and treatment, he proposes that the course of action is driven by the patient’s values. He presents an example of one of his patients who had ovarian cancer. The interaction with friends and families and the avoidance of certain medical devices were highly important to her. Because of these values, the surgery that he completed was more exploratory and less aggressive in nature. It was 100% aligned with her values and wishes.
Dr. Gawande admits that taking this approach, as a doctor, has required him to shift from Dr. Informative to an Interpretive mode where he helps patients articulate and achieve their desires. He writes that he learned a lot from a palliative care doctor including the following questions:
- What is your understanding of where you are and of your illness?
- What are your fears or worries for the future?
- What are your goals and priorities?
- What outcomes are unacceptable to you? What are you willing to sacrifice and not?
- What would a good day look like?
Wishing you the strength that comes from love and the care of an interpretive healthcare team who puts you and your values first.