An interesting TED talk by Atul Gawande discussing some of the problems with the modern medical profession.
I came across this video when reading a recent piece by Dr. Gawande on the medical field’s struggles to clearly explain a terminal patient’s real situation to them, often relying on a blizzard of facts instead of simply telling them what their real chances are, and allowing them to make their treatment decisions with that understanding.
SelfAwarePatterns 
This topic and, of course, the Tolstoy reference, really hit home for me. But I read the article and wondered what the doctor could have done differently. The only option I can think of is to avoid presenting the patient with the option to have the surgery, but then that sounds like malpractice (I’m not sure it is, I’m just guessing). It seems to me that laying out all the possibilities is all a doctor can do. It’s up to the patient to decide, even if he makes a bad decision.
The Tolstoy reference reminds me that people are just people. No one wants to confront death, and things were the same even back then when doctors didn’t specialize as they do now. Our health care system my be horrible on many accounts, but on the subject of confronting death, I don’t see how things can really change.
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I thought of you when I saw that Tolstoy reference.
From the description given, it sounds like the doctors focused too much on giving the patient details, which they probably felt obviously added up to a bleak picture. But my experience is that desperate people rationalize and grasp at straws. The doctors might have done that patient a profound mercy by explicitly telling him how bleak his outlook actually was. It sounds like whatever days his surgery bought him were agonizing ones. If he’d known he was likely going to be dead in 30 days, he might have simply opted for palliative care.
Not that I’m judging the medical people. I agonize over disciplining or firing employees. Telling someone that they are going to die would be unimaginable.
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Unimaginable indeed. Maybe this particular doctor felt he should have been clearer? I don’t know. In any case, it’s a terrible situation to be placed in.
Docs usually tell what the prognosis is in each scenario. But I suppose someone hooked up to a machine with his life at stake and possibly pain medication coursing through his body might need a simpler explanation. It gets tricky though. How do you avoid being persuasive while conveying what’s at stake? I’ve seen this question on doctors faces when they talk to me, and I have to press them with questions, show them my attitudes toward it all, before they will be candid. Even then they answer only the question they’re asked and sort of open their eyes wider as if they expect me to ask the next question so they can say what they really want to say. It’s not so much a fear of death as a desire to stay as objective as possible. If no one asks the questions, doctors usually just assume the patient has understood. And I’m sure they see irrational choices on a regular basis, but they can’t interfere with those choices.
In my father’s case, he understood what was at stake, but opted to do dialysis…it was grasping at straws and he knew it. After one treatment which he called absolute torture he said never mind, let me die. Even some fairly rational people make poor choices in this time, as I’m sure you know. Hell, who knows what I’ll do in that situation.
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I hope, when I reach that point, that I have the presence of mind to ask what my chances are of survival in the next few weeks, and what the doctor would do if they were in my place.
That said, I agree. It’s impossible to know what we would do in that situation until we get there. I suspect life is very hard to give up on. Different people will make different choices. Heck, I’m liable to make different choices depending on my state of mind.
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