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:

COVID-19 amplified America’s devastating health gap. Can we bridge it?

The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.

Willie Mae Daniels makes melted cheese sandwiches with her granddaughter, Karyah Davis, 6, after being laid off from her job as a food service cashier at the University of Miami on March 17, 2020.

Credit: Joe Raedle/Getty Images
Sponsored by Northwell Health
  • The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
  • Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
  • To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
Keep reading Show less

Who is the highest selling artist from your state?

What’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota?

Eminem may be 'from' Detroit, but he was born in Missouri
Culture & Religion

This is a mysterious map. Obviously about music, or more precisely musicians. But what’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota? None of these musicians are from those states! Everyone knows that! Is this map that stupid, or just looking for a fight? Let’s pause a moment and consider our attention spans, shrinking faster than polar ice caps.

Keep reading Show less

Skyborne whales: The rise (and fall) of the airship

Can passenger airships make a triumphantly 'green' comeback?

R. Humphrey/Topical Press Agency/Getty Images
Technology & Innovation

Large airships were too sensitive to wind gusts and too sluggish to win against aeroplanes. But today, they have a chance to make a spectacular return.

Keep reading Show less

Vegans are more likely to suffer broken bones, study finds

Vegans and vegetarians often have nutrient deficiencies and lower BMI, which can increase the risk of fractures.

Credit: Jukov studi via Adobe Stock
Surprising Science
  • The study found that vegans were 43% more likely to suffer fractures than meat eaters.
  • Similar results were observed for vegetarians and fish eaters, though to a lesser extent.
  • It's possible to be healthy on a vegan diet, though it takes some strategic planning to compensate for the nutrients that a plant-based diet can't easily provide.
Keep reading Show less
Scroll down to load more…
Quantcast