I appreciate my readers. One of my readers, Mark Preece, pointed me to a post at the blog dotCommonweal. That post was a recommendation and brief comment about an article online at the website of the New Yorker. The article, titled “Letting Go,” was written by Atul Gawande, a surgeon. It’s an in depth article, the sort of thing the New Yorker is known for, and it’s worth the time to read.
The subject of the article is, really, the difficulty that physicians have being honest with patients when the patient faces a terminal diagnosis. As much as anything else, the cause is that the physicians have difficulty being honest with themselves. Having been educated to think that disease and death are enemies, many physicians are reluctant to stop therapeutic treatment even when there’s no reason to think further therapy will benefit the patient. They’re also inclined to see a patient’s death as a defeat, and both a personal and professional failure. But, as Dr. Gawande notes, “Death is the enemy. But the enemy has superior forces. Eventually, it wins.” Or, as I often say, the mortality rate of being human is 100%
Dr. Gawande does speak well of specialists in palliative care, even as he raises another hindrance. To really understand a patient’s values and to help the patient understand what is and isn’t possible or statistically reasonable takes a great deal of time. It certainly doesn’t help that physicians are paid to apply treatments and not to really sit down and talk to a patient. At the same time, I don’t think lack of reimbursement is the most serious reason that physicians don’t have these conversations, nor does Dr. Gawande. Rather, it is that most physicians aren’t trained to address the personal, and certainly non-clinical issues that really shape how patients hear information and make decisions.
Dr. Gawande is honest about his own difficulties, and clear, too, in his critique of his profession. He offers a worthwhile reflection on what makes it hard for doctors to be clear with themselves and their patients when therapeutic medicine has nothing more to offer.