Helping Patients and Doctors Talk About Death

"Medicare announced plans in July 2015 to reimburse doctors for talking with patients about what treatments they want — and don’t want — toward the end of life. This sensible, long-overdue proposal is likely to have a very wide impact. About 80 percent of people who die in the United States each year are covered by Medicare, and Medicare policies are often followed by private insurers, some of which already pay for these advance-planning conversations.

"Virtually all experts agree that medical professionals will need additional training. Many doctors are uncomfortable talking to patients about planning for death."

See NY Times Editorial.

How to Talk About Dying

by Ellen Goodman, NY Times, July 1, 2015

This is an extraordinary essay.  Well worth studying.  It’s common sense that we need to be reminded of.

Excerpts:

The difference between a good death and a hard death often seemed to hinge essentially on whether someone’s wishes were expressed and respected. Whether they’d had a conversation about how they wanted to live toward the end.

So, a small group of us — each with his or her own story — started the Conversation Project, a nonprofit, out of the belief that surely we could make this easier. (also see the Conversation "starter kit." Our partners at the Institute for Healthcare Improvement gathered experts frustrated at the pace of change who believed that the health care system wouldn’t change until the culture changed. So we are trying to change the culture.

There is now, finally, a real momentum for improving end-of-life care. The signs range from the Institute of Medicine’s report, “Dying in America,” to the success of Atul Gawande’s book “Being Mortal.”

There is also a growing public awareness of the need to break through the reluctance that has kept us tongue-tied for so long. A survey we did last year showed that 90 percent of Americans now think it’s important to have the conversation. But the same survey showed something else: Only 30 percent of us have actually had these conversations. So the gap remains huge.

From all the stories shared with us, we know that what people need most is help getting started. They need a travel guide to take the first steps down an unfamiliar and difficult road. So we created a ConversationStarter Kit.

Dying is not just a medical experience, it is also a deeply human experience.

How Therapicts Grieve

A therapist may spend hundreds of hours, perhaps more than a thousand, hearing about a patient’s most exalted aspirations and most murderous, hateful fantasies. During this time, the patient may endure excruciating losses, unbearable shame, bitter sadness and great triumphs. You may accompany patients through torturous adolescence into adulthood. Or you may meet them in middle age and be with them as they age and eventually die. You collaborate in a deep process of discovery.

Few encounters are this deeply honest, and therefore intimate. The attachment engenders profound feelings, a particular kind of love.

Dr. Robin Weiss' sensitive essay in the NY Times (July 5, 2015) is a good source of insights.