by Kathleen Goodwin
I recently read the surgeon and public health researcher Atul Gawande's latest book, “Being Mortal” in which he writes about end-of-life care in the American healthcare system, which has developed into a series of increasingly radical attempts to postpone death, often at the expense of the comfort of patients during their remaining life. Gawande argues that doctors should refocus their goals on quality rather quantity of life. He advocates for physicians to educate patients about their healthcare options and then assist them in making informed decisions. A few weeks after reading Gawande's book my younger sister was hospitalized for 5 days with an acute case of bacterial pneumonia. An otherwise healthy 22-year old, she was not the type of patient considered in “Being Mortal” but I was surprised to find that many of the topics Gawande described appear to be relevant regardless of the patient's prognosis.
Some healthcare providers have acknowledged that empowering patients and reducing their suffering is a secondary concern in modern medicine and usually far from a priority. A doctor's main goal is to heal but in many cases this seems to lead to a sacrifice of a patient's autonomy and comfort, in the name of an eventual return to full health. It's a practical cost-benefit analysis— distilling years of medical training into layman's terms in order to explain a diagnosis, options for care, and the possible effects of procedures and medications with every individual patient would prevent physicians from having the time to see other patients and would net out to fewer patients healed. In terms of quantifiable success, a patient's experience in a hospital is measured by morbidity and mortality not by the comfort of her stay. Concurrently, in the U.S. healthcare system doctors are generally paid for services rendered and are incentivized to see as many patients as possible.