Editor: The excerpts below are from an article in the Review Section of Sunday, October 5, and are not posted at the NYT’ web site or on the Internet.
By Atul Gawande, MD
NEW YORK TIMES REVIEW:… First, I medicine and society, we have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn those priorities is to ask about them. Hence the wide expert agreement that payment systems should enable health professionals to take sufficient time to have such discussions and tune care accordingly.
I also discovered that the discussion most successful clinicians had with the patients involved just a few important questions that often unlocked transformative possibilities: (10 What is their understanding of their health or condition? (2) What are their goals if their health worsens? (3) What are their fears? And (4) What are the trade-offs they are willing to make not willing to make? These discussions must be repeated over time, because people’s answers change. But people can and should insist that others know and respect their priorities…
Medicine has forgotten how vital such matters are to people as they approach life’s end. People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the ding and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame…
