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.”