Renowned surgeon Atul Gawande discusses mortality and meaning in healthcare, exploring shifts in end-of-life care and the impact of technology. The conversation delves into Hinduism, patient empowerment in medical decisions, and reflections on spirituality. Insights are shared on evolving perspectives in medicine, public life in healthcare, and the professional journey of Atul Gawande.
Western medicine now sees death as a part of life, shifting from failure to expectation.
Advances in technology challenge the decision to stop fighting death, affecting end-of-life care quality.
Atul Gawande's question 'What does a good day look like?' emphasizes embracing mortality to understand being alive.
Deep dives
The Evolution of Western Medicine
Western medicine has shifted from viewing death as a failure to an expected part of life. Technology advances have made it challenging to stop fighting death, impacting the quality of end-of-life care. The emergence of the longevity industry resists acknowledging decline and finitude. Surgeon Atul Gawande's transformative question 'What does a good day look like?' highlights the importance of embracing mortality to understand the essence of being alive.
Redefining the Role of Medicine
The traditional view of medicine as solely ensuring health and survival is being reshaped to focus on enabling overall well-being. Conversations around end-of-life care are shifting to emphasize living a good life until the very end, rather than just fixing or curing ailments. A deeper understanding of patients' goals and priorities helps align medical care with personal values, enhancing quality of life and acknowledging the importance of a good day.
Embracing Mortality and Well-Being
The podcast delves into the struggles of coping with human limitations and mortality, emphasizing the significance of finding meaning beyond our biological constraints. Concepts of spirit, consciousness, and collective human endeavor challenge the conventional perspectives on what it means to be human. The recognition that being human is intrinsically linked to being limited prompts reflections on the interplay between knowledge, technology, and agency in navigating through life.
Variation and Positive Deviance in Healthcare
Exploring the variation in healthcare practices reveals instances of compassionate care amidst potential callousness within the medical profession. Positive deviants demonstrate alternative viewpoints that prioritize connection and empathy, illuminating pathways to enhance patient care. The fusion of clinical expertise with humanitarian values showcases the transformative power of embracing limitations and fostering resilience in healthcare settings.
Expanding Perspectives on Public Health and Medicine
The intricate relationships and dialogues within the healthcare system exemplify the complexities of public life that extend beyond clinical settings. By embracing the limitations inherent in healthcare practices and acknowledging human imperfections, a call to action emerges. Initiatives to facilitate meaningful connections, inspire collaboration, and uphold well-being underscore the evolving landscape of care delivery and societal engagement.
We are strange creatures. It is hard for us to speak about, or let in, the reality of frailty and death — the elemental fact of mortality itself. In this century, western medicine has gradually moved away from its understanding of death as a failure — where care stops with a terminal diagnosis. Hospice has moved, from something rare to something expected. And yet advances in technology have made it ever harder for physicians and patients to make a call to stop fighting death — often at the expense of the quality of this last time of life. Meanwhile, there is a new longevity industry which resists the very notion of decline, much less finitude.
Fascinatingly, the simple question which transformed the surgeon Atul Gawande’s life and practice of medicine is this: What does a good day look like? As he has come to see, standing reverently before our mortality is an exercise in more intricately inhabiting why we want to be alive. This conversation evokes both grief and hope, sadness at so many deaths — including our species-level losses to Covid — that have not allowed for this measure of care. Yet it also includes very actionable encouragement towards the agency that is there to claim in our mortal odysseys ahead.
Atul Gawande's writing for The New Yorker and his books have been read by millions, most famously Being Mortal: Medicine and What Matters in the End. He currently serves as Assistant Administrator for Global Health at the U.S. Agency for International Development. He previously practiced general and endocrine surgery at Brigham and Women’s Hospital in Boston and was a professor at both Harvard Medical School and the Harvard T.H. Chan School of Public Health.
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