Most People Would Prefer to Die at Home. So Why Are We Still Dying in Hospitals?

Physician
Too many people continue to die in hospitals, often in pain and hooked up to machines, when they'd much prefer to die at home in peace surrounded by family and friends. Dr. Angelo Volandes of Massachusetts General Hospital describes this fact as the inspiration for his new book, The Conversation: A Revolutionary Plan for End-of-Life Care. The conversation at the heart of the book is the discussion every family needs to have before serious illness rears its head. In the process of teaching how to have this discussion, Dr. Volandes explores the faults of the medical system at large and offers solutions for major fixes.
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TRANSCRIPT

Angelo Volandes: As a doctor, there have been many experiences that encouraged me and inspired me to write this book. Too often in health care, when we ask our patients where do they want to die, they tell us at home surrounded by their families and loved ones. But the fact is most Americans are still dying in our hospitals, often tethered to machines and in a good deal of pain and suffering. The book addresses the conversation, which is that discussion that patients and families and doctors need to have before they become seriously ill.

There are many reasons for that disconnect between people saying they want to die at home but ending up dying in our hospitals. First and foremost, although we expect our doctors to be master communicators, the fact is we don't really train them on how to communicate to patients. Look, I finished medical school, residency, and even became a young junior attending and I had to show competency in how to run a code, how to perform CPR, how to perform a lumbar puncture, but not a single person actually certified that I could actually talk to a patient and a family about care at the end of life. I think that's a huge problem in our health care system, in our education system that accounts for this disconnect, this misalignment between the type of medical care patients want and the type of medical care they end up getting in our health care system today.

I think there are a lot of things in medicine that have led to this state of affairs. First is look, we live in one of the greatest places in the world where science has conquered a lot when it comes to disease. And so I think the expectation is the next new thing in health sciences, the next new cure. We live in a society that has a denial of aging and a denial of death. I think that's a large reason why doctors are uncomfortable about talking about this, but also we as a society don't like to talk about death and dying at all.

I think a lot of people ask me what should I as a non-doctor know about you the doctor when it comes to this topic? And I would say that look, even though I'm a doctor, I struggle with this as well. And so I look forward to when my patient or my family member tells me, "Hey look, I'd like to talk about this. It's an important part of a good life, a good death as well. And so I'm open to talking to you about what's important to me if I become seriously ill and in need of medical care." I think if more patients started the conversation with their doctors, we'd have a much better patient/doctor relationship. I think doctors need to know that it's okay to broach this inherently difficult subject matter.