Yesterday was a beautiful day in the Northeast. I started out the day with a drive to Manhattan to have breakfast with a dozen physicians and healthcare executives. We had a discussion with Dr. Atul Gawande (2010), Staff Writer for the New Yorker and author of “The Checklist Manifesto”. I will keep the autographed copy of the book on my office bookshelves but I will read it on the Kindle this week. Dr. Gawande made a few comments about healthcare and then opened up for Q&A. Most of the questions and answers centered on the high cost of healthcare and how to best reduce the duplication of efforts and medical errors. This is the focus of his new book and will be the subject of postings here to come.
After the breakfast discussion we headed for the packed SVA Theatre at the New Yorker Festival to hear Dr. Gawande’s talk called “How to Live When You Have to Die”. This is a tough subject. Dr. Gawande cited figures about the staggering cost of healthcare that is expended in the final days of life for millions of people. Even though paliative care can result in living longer, there is an unstoppable momentum to do something. Our impulse is to try anything and everything to preserve life of a loved one when at times this approach results in a nearly unbearable quality of life and significant trauma to family members when the end eventually comes. Hospice is often shunned out of fear of the implications but the result of hospice care is usually more comfort, less suffering for the terminally ill, and less trauma for family members later.
Dr. Gawande believes that the challenge is that doctors often don’t always tell the truth about the prognosis for a person and family members do not want to discuss end of life. He suggested that what is needed is what he called a “breakpoint discussion” with the terminally ill centered around four simple principles. First is an honest assessment of the condition and prognosis. Second is to ask about what fears the person has. Third is to ask about their goals — what do they want for themselves and for their families? Finally is the question of what tradeoffs is the person willing to make — for example, what degree of pain and suffering versus comfort? At the end of his one-hour talk, Dr. Gawande entertained questions. There were many and also many supportive comments about his thesis. At the very end, a young woman walked to the aisle microphone and talked about what it was like to lose her husband to cancer six months ago. She described how they had discussions very much along the lines Dr. Gawande had outlined. She praised the approach but brought the audience to tears.
Atul Gawande is an excellent communicator and is writing about some of the toughest issues in healthcare. I look forward to reading his three books (Better, Complications, and The Checklist Manifesto).
On a brighter note — actually many notes — was an evening performance of the Ridgefield Symphony Orchestra back home in Connecticut. Guest pianist Gayle Martin Henry performed Tchaikovsky’s Piano Concerto No. 1. It was brilliant. The orchestra was in rare form as it played Schubert’s unfinished Symphony No. 8 and Prokofiev’s Classical Symphony.
