In order to provide better medical care to the seriously ill, physicians must ask patients about their goals of care and end of life wishes, said Dr. Atul Gawande, bestselling author of Being Mortal: Medicine and What Matters in the End.
Gawande, a general surgeon at Brigham and Women’s Hospital in Boston, addressed hundreds of medical students and physicians at the University of Chicago Medical School on Thursday. He asked that they listen to patients’ concerns and recognize that prolonging life may not always be the best medical option for the dying.
“We have failed to recognize in medicine and society that people have priorities besides just living longer, that they have aims and goals,” he said. “The most effective way to find peoples’ priorities is to ask. But we don’t ask.” In the hospital setting, the physician often speaks more than the patient, Gawande added.
Some terminally ill patients wish to remain mobile or mentally competent enough to walk their dog or eat at a favorite restaurant; others wish for enough time to say goodbye to loved ones.
“At the end of life, people want to still participate, have a role and make memories,” he said. Because aggressive, often unnecessary, treatments can stymie mobility and cognitive ability, Gawande recommends that doctors familiarize themselves with the benefits of hospice and palliative medicine.
We have failed to recognize in medicine and society that people have priorities besides just living longer, that they have aims and goals
Gawande urged physicians and nurses to ask their patients if they truly understand the nature of their disease. Only with this understanding can a physician begin to provide guidance, he added. Patients and families would be more comfortable enrolling in earlier palliative treatments if they are told about the benefits soon after diagnosis.
Throughout his new book, Being Mortal, Gawande tackles the negative impacts of some relatively new life-prolonging treatments on the seriously ill.
“I never expected that among the most meaningful experiences I’d have as a doctor — and, really, as a human being — would come from helping others deal with what medicine cannot do as well as what it can,” he writes.
Unfortunately, many medical students avoid pursuing careers in geriatrics – care for the aged and ill – often due to the lower pay and the difficult, often emotional, nature of the work.
“Geriatrics is the lowest paying field in the profession. Ninety-seven percent of medical students are not taught about it, but I think it’s beginning to change,” Gawande told Life Matters Media. “End of life discussions are anxiety provoking for everybody involved, partly because they think it’s about giving up, but it’s not. It’s about ensuring we fight for a life worth living.”
David Axelrod, director of the Institute of Politics at the University of Chicago and former Senior Advisor to President Barack Obama, said he appreciated the presentation on a personal level.
“I think Gawande is one of the great thinkers on these issues and how our modern health system works and doesn’t work,” Axelrod told LMM. “I was particularly moved by it, because I just lost my mother earlier this year. A lot of the issues he discussed are what we dealt with.”