Ep50 - Atul Gawande: "Being Mortal: Medicine and What Matters in the End"
Jul 23, 2019
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Atul Gawande, a renowned surgeon and public health researcher, dives into profound themes from his bestseller, exploring how modern medicine often overlooks the true desires of patients facing terminal illnesses. He emphasizes the crucial need for honest conversations about quality of life versus aggressive treatments. Gawande shares poignant stories, illustrating the disconnect between medical care and personal joy, particularly among the elderly. Ultimately, he advocates for a healthcare approach that aligns with patients' values, ensuring dignity and fulfillment even in life’s final stages.
Atul Gawande emphasizes the need for a paradigm shift in medicine from merely prolonging life to enhancing its quality for terminal patients.
The integration of palliative care with traditional treatments significantly improves patients' quality of life and often results in longer lifespans.
Open and honest conversations about patient values and priorities are essential for aligning medical interventions with their true desires and preferences.
Deep dives
The Challenge of Mortality in Medicine
Modern medicine has excelled in addressing treatable conditions but often struggles with the realities of aging and death. As Atul Gawande shares, practitioners frequently focus on curative methods without adequately considering the challenges posed by incurable diseases or advanced age. He emphasizes the need for a shift in thinking from merely prolonging life to enhancing its quality, especially when dealing with terminal patients. This perspective leads to crucial questions about balancing treatment with understanding patient priorities beyond survival.
Reframing Patient Conversations
In his exploration, Gawande finds that conversations about mortality should center not around fighting death, but rather about what constitutes a meaningful life. He recounts instances where patients feel imprisoned by the confines of medical interventions that neglect their personal desires and priorities. For example, he illustrates the experiences of those in assisted living facilities expressing a yearning for autonomy over their daily lives. Identifying and aligning treatment with patient goals transforms the approach to care by prioritizing the quality of life.
Benefits of Palliative Care
Gawande discusses the profound impact of integrating palliative care into traditional oncology treatments, highlighting a study where patients receiving both saw improved outcomes. Those with access to palliative care reported higher quality of life and were statistically less likely to undergo aggressive last-minute treatments. They experienced fewer hospitalizations and lower medical costs, yet importantly, they also lived longer compared to those who did not receive palliative support. This challenges the misconception that focusing on quality care equates to giving up on life.
The Importance of Understanding Patient Values
Atul Gawande underscores the necessity for physicians to engage in deeper dialogues with patients about their values and priorities. He illustrates this through narratives that highlight the often-ignored desires for comfort, family connections, and happiness during the end-of-life stage. In one instance, a piano teacher with terminal cancer expressed the importance of returning to her passion for teaching music, revealing how much fulfillment could be found in her remaining time. Such conversations facilitate better alignment between available medical interventions and the patients' true wishes.
Cultural Perspectives on Aging and Care
Gawande reflects on how various cultures approach aging and end-of-life care, revealing that while Western medicine has made significant strides, it often overlooks holistic care. He notes that as societies transition to more medicalized approaches to aging, the emphasis should shift back to preserving dignity and autonomy among the elderly. The importance of understanding each individual's unique context—social backgrounds, family dynamics, and personal preferences—can guide better care practices. Improved healthcare structures that respect these elements may foster environments in which individuals can maintain their autonomy and lead fulfilling lives until death.
Surgeon, public health researcher, and MacArthur fellow Atul Gawande discusses his #1 NY Times bestseller, "Being Mortal: Medicine and What Matters in the End."
Modern medicine has transformed the dangers of birth, injury, and infectious disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should do. Through eye-opening research and gripping stories of his own patients and family, Gawande reveals the suffering produced by medicine’s neglect of the wishes people might have beyond mere survival. To find out what those wishes are, we need to ask. We haven’t been asking, but we can learn. Riveting, honest, and humane, this remarkable book, which has already changed the national conversation on aging and death, shows how the ultimate goal is not a good death but a good life—all the way to the very end.