What to Say to Your Doctor - Just Finished Reading: Being Mortal by Atul Gawande

"090814-N-7090S-216" by MilitaryHealth

This is an excellent, beautiful book that made me cry a lot because it's written with such sensitivity and attention to the human experience. The people who should read it are: anyone with a serious or terminal illness, caregivers of people dealing with serious illnesses, and anyone not planning to die young. There is great stuff about how our perspectives change when time is short, how doctors can help patients by taking on the role of interpreter and partnering to make decisions, and an in-depth explanation of why nursing homes can feel so bad to be in - because of the loss of autonomy that goes with institutional living.

Two things I want to remember:

1. Real assisted living is a wonderful thing. The underlying idea behind assisted living, in its original form, was that people would live independently and only get help for the things they needed help with. There was a lock on the door to the apartment. The first priority is on autonomy and quality of life, not on safety or the efficiency of the institution.

2. Several times, Gawande describes a valuable conversation that happened between patients coming to the end of their lives and either doctors or adult children. These four questions helped flesh out the patients' priorities in living well in the limited amount of time left to them.

     1. What is your understanding of your condition?
     2. What are your biggest fears and concerns?
     3. What goals are most important to you?
     4. What trade-offs are you willing to make, and what are you not?

In each of the instances he describes, these four questions help tremendously in clarifying the treatment choices that will maximize the patient's quality of life, something that is different for everyone. More than once, an adult child faced with a difficult decision that has to be made quickly about a surgery has clarity about good choices, thanks to having this conversation with their parent beforehand.

There's a lot more to the book. You should go read it.