How Not To Die
Two doctors are developing a tool to help patients and families make fully informed decisions around their medical care, and better communicate with their doctors.
In the May, 2013 issue of The Atlantic, Jonathan Rauch looks into the work of two doctors, Dr. Angelo Volandes and his wife Dr. Aretha Delight Davis, who are making a series of videos to help people make better end-of-life decisions. The videos are a response to what Dr. Volandes believes is "the most urgent issue facing America today… people getting medical interventions that, if they were more informed, they would not want."
As an unintended consequence of the advanced state of medical technology and the medical establishment's mandate to save lives, many people at the end of their lives are faced with a problem unique to our times: unwanted treatment. Rauch writes, "The U.S. medical system was built to treat anything that might be treatable, at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention."
Though there are no statistics on the number of patients who receive unwanted treatment at the end of life, medical professionals seem to agree that because patients make healthcare decisions without being fully informed, many are receiving unwanted treatments as a default. But most doctors are not prepared or able enough communicators to speak with patients about their options.
And so, in response, Dr. Volandes and Dr. Davis are developing a tool to help patients and families make fully informed decisions around their medical care, and better communicate with their doctors. Their videos show patients with a variety of illnesses, and Dr. Davis explains what the most common treatment options are for the condition, and actually shows people receiving those treatments. Then she suggests that people have The Conversation: an open, honest talk with one's doctor about one's condition, the treatment options, and the benefits and risks or drawbacks of each treatment option.
Rauch describes The Conversation this way, in terms of his own father's care:
The momentum of medical maximalism should have slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired.
With his video series, Dr. Volandes hopes to create a platform for true communication between doctors and patients. His goal is that, through systematizing The Conversation, more people will receive less unwanted treatment. Only with communication and The Conversation, and tools like Dr. Volandes' video series, can real change come to the medical establishment's default approach to treating patients at the end of life.
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