We are reviewing the second book in our Aging With Freedom Book Club: Being Mortal by Dr. Atul Gawande.
Dr. Gawande examines choices made near the end of life, from his perspective as both a surgeon and as a son. He shares his walk alongside his father during his father’s final months. Through this experience, Dr. Gawande concludes the quality of daily life needs to be a higher priority in the final stage of life. Time without quality is of little value. Dr. Gawande lovingly discusses the grace and compassion needed in this final walk.
The Big Three Questions to Ask
Being Mortal‘s central thread is condensed into three big questions. The answers to these questions define the patient’s final priorities and associated care. The patient’s priorities, not the physician’s or the family’s. According to Dr. Gawande, the patient’s priorities should become the physician’s and family’s priorities. So ask patients:
- What are your biggest fears?
- What goals are important to you?
- What trade-offs are you willing to make and what trade-offs are you not willing to make?
Dr. Gawande witnessed hospice nurses asking similar questions of their patients. These questions helped patients define their priorities and share these priorities with their family. Interestingly, Dr. Gawande found patients were often better at dealing with the reality of these choices than their own family members. Or physicians. Physicians rarely start or facilitate these difficult conversations.
Pick up this book and let us know what you think. We found it to be a thoughtful look at end of life. Dr. Gawande shares with his readers how to ask and frame these three questions for your life and loved ones.
We will all walk those final steps. Death comes to us all. Patients are empowered through this final life phase by asking about priorities, goals, and trade-offs. And directing final care appropriately. Planning and answering these questions aids our loved one’s final care. And improves the experience of the family and the caregivers. It relieves much of the emotional burden for family caregivers and medical providers. Empowering patients promises a better life’s end.
The current default setting in health care is aggressive, even hopeless, pursuit of a cure. Too many medical providers ignore palliative care. Hospice is under-utilized as if recommending palliative care is an admission of failure. The medical complex is used to telling patients what to do to get better. When there is no “better,” physicians are slow to convey bad news. The status quo is provider-directed care. Dr. Gawande proposes to reverse the roles and have the care providers answer to the patient. This theme of patient-directed care is an emerging “best practice” across a range of senior services and health care. It requires proactive patients (and families) and responsive, service-oriented providers. Providers must be willing to do things for patients, not to them.
Dr. Gawande was the featured speaker at the Leading Age 2016 conference in Boston. We chose this book to prepare for this event. Dr. Gawande is already well-known for the Checklist Manifesto, bringing to medicine the discipline of complex safety systems such as pilots use in aviation pre-flights. Being Mortal, by contrast, is a very human glimpse into the challenges faced by physicians, family caregivers, and dying patients. The keynote address was, similar to the book, compelling and personal.
We left impressed with Dr. Gawande’s intellect and compassion. And he had the storyteller’s gift for infusing life, even humor, into a narrative about how to die.
Bottomline? Life and the experience of death would be better for all if dying patients are more directly involved in the hard choices of quality of life now versus exhaustive life extension. Empowering patient-centered care means honest, difficult physician conversations with a dying patient, earlier rather than later.