Editor’s note: This article is part of Next Avenue’s 2015 Influencers in Aging list honoring 50 people changing how we age and think about aging.
Being Mortal. The depth of meaning in the title of Dr. Atul Gawande’s latest bestseller is revealed as you read. This is a book as much about living, or being, as it is a treatise on facing life’s end.
Its premise is that people with terminal conditions are too often given false hope and overtreated in the medical system. Instead, Gawande argues, we should ask those patients what they want from their remaining days.
Doing so allows them to have choices and often, when they forgo escalating medical interventions, time — the time to settle their affairs, fulfill final wishes and, most importantly, focus on their most important relationships.
If Gawande’s ideas about these conversations become part of the norm, this country’s approach to care would radically change. That just might happen. His suggestion to learn what patients want fits with a broader, growing national conversation, one that holds patient-centered models as an ideal in caring for the elderly.
How a Surgeon Started a Movement
As a national PBS service for people over 50 (many of whom are caregivers for their parents), Next Avenue is proud to honor Gawande for his role in pushing for changes many of us endorse. His unique perspective as a doctor and son longing to help his dying father allowed him to prod his profession forward. His ability as a writer helped the rest of us gain insight into how patients wind up misinformed and misunderstood — and gave us hope that the system can be transformed.
If Gawande's ideas about these conversations become part of the norm, this country’s approach to care would radically change.
Gawande’s brilliance has been in creating systems for medical personnel to ensure quality care. His previous bestseller, The Checklist Manifesto, provided a standardized approach to surgery that any surgical team could adopt to make sure, for instance, that doctors operated on the proper limb.
Being Mortal provides a checklist that any medical professional can use to make end-of-life care patient-focused. By asking Gawande’s five questions, doctors can restore control, dignity and time to those who are critically ill.
When I interviewed Gawande earlier this year about a PBS Frontline documentary based on his book, he talked about helping patients and their families discover their priorities as options for medical interventions dwindle. “People do have priorities in addition to living longer,” Gawande said. “The most reliable way to know what those are is to ask, and we don’t ask. We ask less than a third of the time.”
5 Questions to Ask
By creating a list of five questions, Gawande wants to nudge his profession to ask all of the time, and at multiple points throughout an illness, since priorities constantly change.
The questions are:
1. What is your understanding of where you are and of your illness?
2. What are your fears or worries for the future?
3. What are your goals and priorities?
4. What outcomes are unacceptable to you? What are you willing to sacrifice and not? And later,
5. What would a good day look like?
“It needs to be normal to ask these questions,” Gawande said.
By instilling a focus on what a patient wants throughout an illness and at the end of life, the care system in this country would ultimately become patient-centered, with doctors listening instead of telling and fixing.
As Gawande has pointed out, families can also use the questions to continually check in with their loved ones and each other. That means less time worrying and more time spent accepting, feeling, sharing. Being.
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