Doctors face an almost impossible dilemma when it comes to end-of-life care. They want to do everything possible to keep their patients alive and healthy for as long as possible. But there are times when an illness is so painful and debilitating that a person simply loses the will to go on living. Sometimes, the most humane care is not about prolonging life.
Dr. Atul Gawande discovered this the hard way. “I learned virtually nothing about mortality when I was in medical school,” he says. “I was terrible at knowing how to have a successful conversation with people facing terminal illness.” Early on, he felt lost when talking with terminally-ill patients. He realized that having these conversations was a skill he would have to master, as surgery was. Now, Gawande, author of the bestseller, “Being Mortal,” is trying to help physicians and families talk about finding better ways to live out the final chapter.
He tells Steve Paulson that physicians still have a great deal to learn about end-of-life care.
Interview Highlights
On difficult conversations
I found that the hardest conversations are the ones where I didn’t even know what I was doing. Even breaking bad news to people, I felt that people sometimes hated me, that I wasn’t conveying that I was concerned about them. Somehow I was just giving them cold, hard facts. People described it as….‘It was like you took a sledge-hammer to me. It was like you didn’t really care.’ That was the really hard thing for me.
On why death is not failure
The world I trained in and the way I thought about being a surgeon was that dying is failure. And it is our number one battle. But what I learned from folks was that the [real] failure is not making life as good as possible all the way to the very end.
People have priorities besides just living longer. And the most reliable way to learn what those priorities are is to ask about them. And we don’t….We don’t realize that for most people, a life worth living is bigger than just being safe and alive.
Dr. Gawande also discusses many of these issues in much greater detail with Anne Strainchamps, who sat down with him as part of the Wisconsin Book Festival on October 24, 2014. See the complete video below: