Lessons From Being Mortal

Atul Gawande Being Mortal

The doors to the subway car opened and I burst out, running in hopes of hearing Atul Gawande speak about his most recent book, Being Mortal, in a talk he was giving in New York recently. My hopes were dashed as soon as I arrived, though, when I was told that there was no chance I was getting in, the room was packed to the brim.

For anyone who has read Being Mortal, this shouldn’t be surprising. In his book, Gawande broaches the subject no one wants to talk about–death–with a rare sense of humanity, care, and consideration that has resonated with people on both sides of the medical curtain.

Gawande originally wrote Being Mortal for doctors, but it has since become a sensation, currently holding the number one position in both Health and Science on the New York Times’ bestseller list. The book is the culmination of Gawande’s thoughts on the nature of patient-doctor relationships in the face of serious illness and decline. At the heart of it is an insistence that improved communication between doctors and patients is the key to a better healthcare system.

As a doctor himself, Gawande offers a rare, bird’s-eye-view of the profession. He describes the two most common types of doctors you meet when you have a serious health condition: the Informative Doctor and the Paternalistic one.

The Paternalistic Doctor “knows best.” She/he will prescribe what they believe to be the best therapy for the patient with little outside input. Instead of offering options, they’ll say, “We will do this surgery. It will be good for you.”

This is the type of doctor many of us grow up with. While patients tend to look for decisive answers when they seek treatment, many Paternalistic doctors use one-size-fits-all recommendations, rather than consider patients’ individual circumstances. Generally speaking, the medical community has come to an agreement that this is bad medicine.

The Informative Doctor, on the other hand, has a whole litany of different medicines, therapies, and procedures; all you have to do is pick one. Informative Doctors may even offer the variety of options out of fear of discussing the reality of a patients’ illness. “You can always try x or x,” they’ll say. And with all of the things to consider when you are ill, the large variety of treatment options can become overwhelming. While patients should be the masters of their own destiny, it’s a disservice for doctors to not offer their own advice and concerns as clinical experts.

As an alternative, Gawande offers the Interpretive Doctor: the new doctor for the 21st century. The Interpretive Doctor first listens to his or her patients and uses the patient’s understanding and wishes to guide their recommendations for treatment. Gawande champions four essential questions that can be used to establish a successful patient-doctor dialogue, drawn from the field of palliative care:

  • What is your understanding of the situation and its potential outcomes?
  • What are your fears and what are your hopes?
  • What are the trade-offs you are willing to make and not willing to make?
  • What is the course of action that best serves this understanding?”

These questions help to establish a connection between doctor and patient and makes sure that patient and doctor understand one another and understand the nature of the patient’s illness. I must admit the concept of an Interpretive doctor, one that both listens and is decisive, was a particularly impressive revelation to me as an aspiring physician.

After I finish my internship with the Partnership for Palliative Care, I will begin pre-medical post-baccalaureate studies. I was not one of those kids who knew they wanted to be a doctor from birth. In fact, it was only a few years ago that I became interested in medicine after a confusing journey through the medical system. I thought, “If I’m having this much trouble understanding my care as a healthy 20-something, what happens to people living with chronic and serious illness? How can I make it better?”

Favorite buzzwords among young doctors and doctors-to-be are “continuity”, “holistic approach” and “patient centered.” We’re idealists at heart. But at this pivotal moment in healthcare in America, it can be hard to see the ways we can effect change on both a micro and macro level in our careers. Being Mortal offers a beautiful account of the ways doctors and patients touch each other’s lives and a path to a collaborative future. It is a must read for everyone whose life has been or will be touched by illness.