Surgeon and Best-Selling Author Atul Gawande Reminds Us What Truly Matters in the End
September 7, 2017 02:52 PM
Photo by Tim Llewellyn
Atul Gawande, a surgeon practicing general and endocrine medicine at Brigham and Women’s Hospital in Boston, and the New York Times best-selling author of Being Mortal: Medicine and What Matters in the End, spoke with health care policy journalist Sarah Kliff to a sold out crowd at Sixth & I Historic Synagogue last night in Washington, D.C.
Since the release of Being Mortal three years ago, Gawande has seen a cultural shift in how we approach life and talk about death. More Americans are choosing to live meaningful lives until the very end, insisting on aging in place or receiving care at home for as long as possible or receiving hospice care at home when that time comes. Even adult children of the elderly and infirm are seeking better options for their loved ones. Instead of just focusing on whether or not their parent, friend, or relative will be safe at a nursing home or in an assisted living facility, they want to find a place where they will also fit in, be engaged, and be able to participate in activities that make them happy.
Gawande says telling someone they have terminal and inoperable cancer is never easy, but communication style can make all the difference. He encourages health care providers to ask people what they want because otherwise the care delivered is misaligned with the patient’s needs, which leads to regret and suffering. Clinicians must know when to take on the role of a counselor and ask difficult questions. They must take the time to discover a patient’s priorities, fears, and hopes as they age or deal with a terminal illness. Is a good life defined by being able to eat ice cream and watch football in their living room? Or is it something more? What happens when they are no longer able to enjoy these simple pleasures? What does their plan of care look like toward the end of life?
This is a shift from what medical students are taught in school. It’s no longer enough to present the pros and cons of a treatment, or to present the risks and benefits of taking a medication. It’s about learning how to talk to people and about having hard conversations. Gawande admits he was frustrated and confused about how to become competent in discussing death and dying with patients and their families, but he has made great strides and now serves as a guidepost for others. He reminds us “It’s really about living, not about dying. It’s about having a good life until the very end.”