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Atul Gawande, author of The Checklist Manifesto: How to Get Things Right, discusses his book and offers his take on how to improve our healthcare system.
So, you think that a discussion that currently happens with virtually every doctor now, whereby a doctor gives his/her "frank" opinion on health/maladies (since that's all it ever is), will take a turn for the coercive so as to end the patient's life?
Just as interesting is your implication that at some theoretical date in the future you will be forced to discuss with your doctor his preference for your death.
Now that i think of it, you're right. It seems that American doctors are going down down the coercive "death panel"/euthanasia path.
Where are those death panels again? Oh yeah; in Jan Brewer's office withholding AZ state funds for organ transplants and demonstrably causing deaths within the American population.
"Yes, Gov. Brewer, Arizona does have a death panel"http://www.azcentral.com/arizonarepublic/news/articles/2010/12/09/20101209Montini1209.html
RCT from NYC, you obviously do want to have an end-of-life discussion. You want your doctors to make every possible effort to keep you alive. That's the whole point. Other people wouldn't want to be kept breathing or nourished by machines. These discussions allow doctors to know who is who, and you don't have to wait until you're really sick to stake out your position.
As a sixty year old New Yorker who works full-time at two jobs, runs 3 miles a day, and hopes to continue work, and otherwise continue live an active, healthy life, for a long time, I am worried by the increasing emphasis in the media and in Washington on death, dying, the alleged "delusions" and selfishness of those people my age who believe that they have many years of work and health ahead of them, the costs of caring for the terminally ill and now, the benefits to the terminally ill of foregoing further treatment. Frankly, I think that society is trying to make us feel guilty about remaining alive. We are expensive and soon to be a noisy, insistent a pain in the rear end; why not persuade us to commit suicide?
Seriously, a "frank" discussion with a doctor who is convinced that your time has come, and that you are irrational to think otherwise, would be very, very discouraging and coercive, particularly when you are, as you would be, seriously ill. I don't want to have such a discussion. Anyone who wants to stop treating me will have to do so, literally, over my dead body.
How can we "boomers" organize to avoid the real death panels, i.e., all those well-meaning "rational" types who are driven by social and economic forces that they do not understand to end our existence on this good earth. How about "AWE" -- "Americans With Experience" -- or "BABY" -- "Boomer's Ain't Bodies YET"
a good diagnostic doctor doesn't need a list. he or she observes and listens. a good driver doesn't go through a checklist before turning the key to start the car. both need to be receptive to the unexpected.
i have lupus and a yr and a half ago my lupus caused sever neuropathy and paralysis and the docs talked me into chemo and into dialysis and a month after doing it and seeing no results, my rheumatologists came into my hospital room one day and told me, "sorry, there's nothing else we can do for you.." and just stood there shrugging as I asked them in tears about what I was supposed to do next. and then they said sorry in a very off-putting, non-personable way, and left. i called my friend right after, because i was so mad and upset, and she was pissed too. so she called the admin folks at bellevue because she couldn;t believe that the docs would be so stupid to do this and the admin said they weren't allowed to come talk to a patient as sick as i was while i was alone and tell me there's no hope in my condition. so she made the docs come back latr when my family was there and apologize for telling me that way and that they wouldn't give up. luckily a few new docs came on. and although they couldn't "fix" me, they never gave up trying. some of the docs, though, have the WORSE bedside manner. since i have lupus and heart problems and a blooding clotting disorder, ive been in the hospital alot in the last 10 yrs, ive had so many different experiences with docs. i think though, for ppl like me who have unpredictable diseases that make things life altering and sometimes terminal, you need to be considerate. especially when they're young and want to live and are doing what they can to live. it just amazes me that docs who go into areas where they'll have to tell ppl difficult things, that they have no idea how to talk to ppl. so i hope this form of training makes it to Bellevue and NYU in Manhattan.
The problem with end of life care for conservatives is solely this: Is the advice coming from the MD----whose clinical judgment should be used in the best interest of the patient----or is it coming from government, whose aim is to reduce costs.
That dual and conflicting role was best represented by the woman who called about her mom with cancer. Too often, the decision by oncologists is based on stage migration, rather than patient survival or quality of life considerations.
Another problem is cost. The insurance model drives up cost. If we insured ourselves for running low on bananas, the cost of bananas would be $3 a pound. And we add to the cost "preexisting conditions"! If i drive to Geico with a broken windshield, expecting them to repair it BEFORE I subscribe to their insurance, they would laugh at me and inform me that they run an INSURANCE business, in which risk is assesses BEFORE you join. not after. We currently do not have a health insurance industry. I don't know what to call it, other than "unnecessarily expensive."
bmateer, a checklist can ensure that the doctor *is* listening to a patient during a diagnosis. Obviously, a doctor shouldn't act like a robot working through a programmed set of questions, but a checklist could definitely help in getting a complete picture of the patient's history and symptoms.
I have to disagree somewhat w/Dr. Gawande on what the caller's mother's doctors should have told them. Not just that it can be difficult but specifically what it's like to be on radiation therapy. Patients & their families have the right to be fully informed about all the likely effects of the treatment they're offered. I can understand the caller's feeling that the doctors were experimenting on her mother, but if it had actually been an experiment, they'd have been legally required to obtain *informed* consent.
My 90+ yr old parents live in rural New Jersey. My mother had a bad stroke 8 years ago. My father & a helper take care of her lovingly. She has new strokes from time to time making her even more debilitated (she cannot talk or read or write). If she has a problem my father must call 911, must wait 20 minutes for an ambulance, must take the ambulance 40 minutes to the nearest hospital where they triaged & patronized. He would like to get her defined as a "hospice" candidate which would mean that the Visiting Nurse would come to the house & stabilize the situation - , the only way to avoid ending up in a hospital, the only way my mother can die at home. The doctor says she's not sick enough & refuses to put her in this category. As a result, if my mother say falls & badly cuts her head, my father mops her up & sticks her in bed. The system is wrong!
Well Dr. Gawande represents 1 in a thousand doctors. Many could care less to hear what's going on with you.
How about those 3 minute visits after waiting for an hour!
My eMail signature includes the quote:"Do not put down to evil intent what can equally well be explained by thoughtlessness."
Even a Checklist containing nonsense items can cause people to Pause and THINK.
Like the knowledge that you are being observed can improve factory workers performance.
a check list may work well in an operating room but it doesn't work well when a doctor is diagnosing the patient--listen to the patient not a list of preconceptions
how valid really is a health care proxy?
Your book highlights the team approach in medicine, as opposed to the older model of the heroic physician in total charge. My daughter who works for the FAA tells me that this is the new approach they are also working toward - a no blame-team approach to solving problems in complicated situations.I loved the book and started to think about how I could use it in my own work life - the college classroom
I go to a medical group ( Mt Kisco ) which is convenienently located down the street from me.I like my primary care doctor. But every time I see her , she is constantly looking at her watch and trying to speed me along. Would I feel less rushed at a smaller group?BTW - The wife of the group's chief executive ( formerly a practicing specialist ) was recently elected to the new House of Reps ( 19th district ) . Coincidence?
I'm quite pleased that our guest speaker has not referred to the Healthcare Reform Bill in the pejorative expression--"Obamacare."
Personally I would be proud to have my name attached to this monumental attempt to reform our healthcare system--but that is certainly not the way people want others to hear "Obamacare."
I caught Brian L using this term--please understand that it is not a neutral, fair, nor balanced expression.
Anyone who thinks there is "white" and "Black" blood is an idiot and doesn't know that (a) blood is really blue.
I understand politicians and the general public not understanding completely the medical issues such as the end of life care you discussed, but where do most in the medical professions (doctors, nurses, lpns) stand on these issues)...can't they take the lead on these debates?
I have a suggestion for a future segment on the show, or maybe a crowdsourcing project: what other systems could be improved by use of a checklist, & what should be on the checklist for each of them?
What about care for the elderly after a fall? My 94 year old grandmother fell and broke her hip and wrist. Her insurance only covered 2 weeks of rehab but she still can barely get out of bed! Even her therapists said she needed to stay in the rehab facility for another month at least. I thought medicare was supposed to kick in for stuff like that? What's the point of reform when there are holes like this! If she stayed in the nursing home it would cost 400 dollars PER DAY! She lives on a fixed income with my step grandfather, who's much younger than her but also in poor health. Their only asset is an 100 year old house which is not worht anything and small pension. What choice does she have? To give up her house. Where is my grandfather supposed to go?
Most professionals, other than Doctors and Lawyers are paid "salaries" for their work and are not "piece meal" workers. Why can't a hospital just hire Doctors in given specialties and pay they a salary and not worry about "piece mealing"?
Please don't leave pain control off your list of considerations in end-of-life care. (Maybe it should be called something else--I can just see right-wingers twisting it into "end-your-life care"!)
Atul Gawande ROCKS! Seriously -- his New Yorker articles are must reads. The Check List Manifesto is brilliant.
For profit insurance companies do not care about health care. It's a business and they answer to Wall St.
Read "Deadly Spin" by Wendell Potter.
Obama should have pushed for single payer universal health care, then the Republicans would have looked jerks for trying to repeal that.
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