Posted on 2010-07-29 15:58:00
Atul Gawande has a new article about how our health system does a bad job at end-of-life issues, and how hospice care is really a pretty good idea if the patient wants it, and how really the most important thing is to decide what kind of treatment you want before something terrible happens. WARNING: really really depressing! Here's a good summary:
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.
More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time—just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.
Comment from cifarelli:
After watching all three of my grandparents die in hospitals under circumstances that were really not pleasant (the 4th died before I was born), hospice care sounds really good to me. I'd much rather die at home than go through what I saw them endure by dying in a hospital.
And I hope I'll be able to make that decision for my own parents when the time comes, if they aren't able to make it for themselves.
Comment from mathjoker:
Not really responsive to the topic of the article, but I think Atul Gawande is one of the greatest minds of our time, and the way he writes about his area of expertise is one-of-a-kind.
And I agree with what he says here.
Comment from gregstoll:
Agreed. I've read his book The Checklist Manifesto: How to Get Things Right twice already, and I'm going to read it again to give it a proper review soon :-)
Comment from gerdemb:
The analogy of doctors fighting death as a war is a good one. It's a war you can't win...
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