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Doctors Must Improve How They Talk to Patients About Death

Dr. Atul Gawande's new book Being Mortal explains how doctors focused on saving lives often find themselves unprepared to guide terminal patients toward their inevitable ends.

Doctors Must Improve How They Talk to Patients About Death

Doctors spend years training to keep patients alive. Rarely are they prepared to help them die.


Such is the crux of Dr. Atul Gawande's new book Being Mortal: Medicine and What Matters in the End. In it, Gawande grapples with how modern medicine deals with (or fails to acknowledge) the inevitability of death  A touching and thought-provoking excerpt from Being Mortal is available to read over at NY Mag.

Gawande discusses how the only real training he received in medical school was the reading of Tolstoy's The Death of Ivan Ilyich, in which the title character succumbs to an unknown malady without receiving the sympathy or guidance he seeks from those around him. Gawande saw life imitate art in his first year as an intern when he was tasked with obtaining consent from a terminal patient for a risky surgery that had no chance of saving him:

"If he was pursuing a delusion, so were we. Here he was in the hospital, partially paralyzed from a cancer that had spread throughout his body. The chances that he could return to anything like the life he had even a few weeks earlier were zero. But admitting this and helping him cope with it seemed beyond us. We offered no acknowledgment or comfort or guidance."

Gawande notes that this is unacceptable in a day and age where aging and dying have become medical experiences. Back in 1945, most people died in their homes. As Gawande explains, that figure has plummeted since: 

By the 1980s, just 17 percent [died in their homes]. Those who somehow did die at home likely died too suddenly to make it to the hospital — say, from a massive heart attack, stroke, or violent injury — or were too isolated to get somewhere that could provide help.

This massive transition in the way we die has not been met by necessary shifts by modern medicine. With so much death around them, doctors tend to focus only on keeping patients alive. Gawande wants more medical professionals to be aware that their responsibilities now include helping patients cope with mortality:

"Modern scientific capability has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical world have proved alarmingly unprepared for it."

Read more at NY Mag

Photo credit: wavebreakmedia / Shutterstock

Dr. Awal Gawande is also one of hundreds of Big Think experts. Below is a clip from his Big Think interview about what doctors fear:

Radical innovation: Unlocking the future of human invention

Ready to see the future? Nanotronics CEO Matthew Putman talks innovation and the solutions that are right under our noses.

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Innovation in manufacturing has crawled since the 1950s. That's about to speed up.

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Your body’s full of stuff you no longer need. Here's a list.

Evolution doesn't clean up after itself very well.

Image source: Ernst Haeckel
Surprising Science
  • An evolutionary biologist got people swapping ideas about our lingering vestigia.
  • Basically, this is the stuff that served some evolutionary purpose at some point, but now is kind of, well, extra.
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Quantum particles timed as they tunnel through a solid

A clever new study definitively measures how long it takes for quantum particles to pass through a barrier.

Image source: carlos castilla/Shutterstock
  • Quantum particles can tunnel through seemingly impassable barriers, popping up on the other side.
  • Quantum tunneling is not a new discovery, but there's a lot that's unknown about it.
  • By super-cooling rubidium particles, researchers use their spinning as a magnetic timer.

When it comes to weird behavior, there's nothing quite like the quantum world. On top of that world-class head scratcher entanglement, there's also quantum tunneling — the mysterious process in which particles somehow find their way through what should be impenetrable barriers.

Exactly why or even how quantum tunneling happens is unknown: Do particles just pop over to the other side instantaneously in the same way entangled particles interact? Or do they progressively tunnel through? Previous research has been conflicting.

That quantum tunneling occurs has not been a matter of debate since it was discovered in the 1920s. When IBM famously wrote their name on a nickel substrate using 35 xenon atoms, they used a scanning tunneling microscope to see what they were doing. And tunnel diodes are fast-switching semiconductors that derive their negative resistance from quantum tunneling.

Nonetheless, "Quantum tunneling is one of the most puzzling of quantum phenomena," says Aephraim Steinberg of the Quantum Information Science Program at Canadian Institute for Advanced Research in Toronto to Live Science. Speaking with Scientific American he explains, "It's as though the particle dug a tunnel under the hill and appeared on the other."

Steinberg is a co-author of a study just published in the journal Nature that presents a series of clever experiments that allowed researchers to measure the amount of time it takes tunneling particles to find their way through a barrier. "And it is fantastic that we're now able to actually study it in this way."

Frozen rubidium atoms

Image source: Viktoriia Debopre/Shutterstock/Big Think

One of the difficulties in ascertaining the time it takes for tunneling to occur is knowing precisely when it's begun and when it's finished. The authors of the new study solved this by devising a system based on particles' precession.

Subatomic particles all have magnetic qualities, and they spin, or "precess," like a top when they encounter an external magnetic field. With this in mind, the authors of the study decided to construct a barrier with a magnetic field, causing any particles passing through it to precess as they did so. They wouldn't precess before entering the field or after, so by observing and timing the duration of the particles' precession, the researchers could definitively identify the length of time it took them to tunnel through the barrier.

To construct their barrier, the scientists cooled about 8,000 rubidium atoms to a billionth of a degree above absolute zero. In this state, they form a Bose-Einstein condensate, AKA the fifth-known form of matter. When in this state, atoms slow down and can be clumped together rather than flying around independently at high speeds. (We've written before about a Bose-Einstein experiment in space.)

Using a laser, the researchers pusehd about 2,000 rubidium atoms together in a barrier about 1.3 micrometers thick, endowing it with a pseudo-magnetic field. Compared to a single rubidium atom, this is a very thick wall, comparable to a half a mile deep if you yourself were a foot thick.

With the wall prepared, a second laser nudged individual rubidium atoms toward it. Most of the atoms simply bounced off the barrier, but about 3% of them went right through as hoped. Precise measurement of their precession produced the result: It took them 0.61 milliseconds to get through.

Reactions to the study

Scientists not involved in the research find its results compelling.

"This is a beautiful experiment," according to Igor Litvinyuk of Griffith University in Australia. "Just to do it is a heroic effort." Drew Alton of Augustana University, in South Dakota tells Live Science, "The experiment is a breathtaking technical achievement."

What makes the researchers' results so exceptional is their unambiguity. Says Chad Orzel at Union College in New York, "Their experiment is ingeniously constructed to make it difficult to interpret as anything other than what they say." He calls the research, "one of the best examples you'll see of a thought experiment made real." Litvinyuk agrees: "I see no holes in this."

As for the researchers themselves, enhancements to their experimental apparatus are underway to help them learn more. "We're working on a new measurement where we make the barrier thicker," Steinberg said. In addition, there's also the interesting question of whether or not that 0.61-millisecond trip occurs at a steady rate: "It will be very interesting to see if the atoms' speed is constant or not."

Self-driving cars to race for $1.5 million at Indianapolis Motor Speedway ​

So far, 30 student teams have entered the Indy Autonomous Challenge, scheduled for October 2021.

Illustration of cockpit of a self-driving car

Indy Autonomous Challenge
Technology & Innovation
  • The Indy Autonomous Challenge will task student teams with developing self-driving software for race cars.
  • The competition requires cars to complete 20 laps within 25 minutes, meaning cars would need to average about 110 mph.
  • The organizers say they hope to advance the field of driverless cars and "inspire the next generation of STEM talent."
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Mind & Brain

The dangers of the chemical imbalance theory of depression

A new Harvard study finds that the language you use affects patient outcome.

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