I have been slow to take up noted surgeon and author Atul Gawande's impressive New Yorker article about palliative care, hospice, end-of-life decision-making and our medical system's chronic inability to guide seriously ill patients toward treatment choices and decisions that reflect their realities and their values. Released online last week and published in the August 2 print issue, this 13-page article really gives the comprehensive New Yorker treatment to issues that hospice and palliative care advocates have long wrestled with. And it has created a great stir across the blogosphere, generating multiple responses and comments, mostly very positive.
Just to take a few examples, Brad Stuart writing at the GeriPal blogsite suggests that helping patients with these issues ultimately takes personal work of a spiritual nature by health professionals. An unnamed blogger at the Health Insurance Resource Center at healthinsurance.org offers a personal take drawn from his mother's hospice work and from caring for his 92-year-old grandmother as her life was winding down. Even the Wall Street Journal's Health Blog and the Healthcare FInancial News blog by Mike Stephens have gotten into the act. And these examples just scratch the surface of what's been coming my way via Google Alerts and Google Reader.
Gawande introduces his readers to hospice care by noting, "I didn't know much about hospice," and then follows hospice nurse Sarah Creed out on her visits to dying patients. He succeeds in capturing the nuances of what hospice really does, as well as acknowledging his difficulties in being honest about prognosis with his own patients. He cites research suggesting that patients who enroll in hospice don't necessarily die faster than equally ill patients who don't, and impressive experiments in simultaneous hospice and curative care by the Aetna insurance company.
And he notes in passing, as do many of his commentators, the ugly political pandering of those who tried to derail health care reform with cries of "Death Panels." They represented a serious setback to the kind of serious, in-depth national conversation that our society and health care system need to engage in around the momentous issues of human mortality and the costs and benefits of intensive medical treatments in life's final stages. A recent article in The Forum of the Berkeley Electronic Press, "The Politics of Health Care Reform" by Brendan Nyhan of the University of Michigan, suggests about these death panel demagogues: "Increasing the reputational costs for dishonest elites might be a more effective approach for improving democratic discourse."
In the meantime, perhaps Gawande's article can give a much needed boost to that national discourse around "how we can build a health-care system that will actually help dying patients achieve what's most important to them at the end of their lives."