Atul Gawande, a cancer surgeon and author, was concerned
that his colleagues and he were not handling end of life matters well with
their patients. He researched a book, Being Mortal (October 2014) on
what has gone wrong with the way we manage mortality and how we could do
better. He writes:
“I spoke with more than 200 people about their experiences
with aging or serious illness, or dealing with a family member’s. Among the many things I learned, here are the
two most fundamental.
First, in medicine and society, we have failed to recognize
that people have priorities that they need us to serve besides just living
longer. Second, the best way to learn those priorities is to ask about them.
I also discovered that the discussions most successful
clinicians had with patients involved just a few important questions that often
unlocked transformative possibilities:
(1) What is their understanding of their health or
condition?
(2) What are their goals if their health worsens?
(3) What are their fears? and
(4) What are the trade-offs they are willing to make and not
willing to make?
These discussions must be repeated over time, because
people’s answers change. But people can and should insist that others know and
respect their priorities."
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