THE NEW YORKER. ANNALS OF MEDICINE. LETTING GO. What should medicine do uhen it can’t suve pour life? by Atul Gawande. AUGUST *. >> wait. Gawande begins “Letting Go” with the story of Sara Thomas Monopoli, 39 weeks pregnant with her first child “when her doctors learned that. I want to draw people’s attention to a fantastic new piece in the New Yorker by Atul Gawande titled, “Letting Go: What should medicine do when.

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And once someone is very ill, handing them a directive to fill out seems to me a pretty abrupt way to start the conversation. Factors considered important at the end of life by patients, family, physicians, lerting other care providers. But as Gawande suggests, the toughest issues we face turn on questions about the purpose of medicine, and, I gawwande add, the relationship between doctor and patient. Once again, higher quality care translates into more affordable care.

Letting Go: What Should Medicine Do When It Can’t Save Your Life?

I could go on. This woman, consciously or not, is dealing with the nearness of death. I assume patients with a terminal illness would have different attitudes towards palliative care depending on their state of mind.

Gawande writes that by many objective metrics, patients who seriously discussed end-of-life care ended up suffering less:. They expect the patient to cover the difference. As Sara and Rich later told the social worker who was sent to see them, they did not want to focus on survival statistics.

Goo least she was spared at the very end. She had a right to know. They focus on laying out the facts and the options. The firefighter was Many of these letying will survive, and go home. If the pilot is succesful, Medicare could roll it out nationwide, without needing approval from Congress. See the history of other once-prosperous empires. Feet aren’t ugly A remarkable story of how one hospice volunteer connects with patients and families through their feet.


The goal is not to cut costs and curtail suffering by shortening the process of dying. But the third who did were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an leting unit. A patient like Sara Monopoli could continue to try chemotherapy and radiation, and go to the hospital when she wished—but also have a hospice team at home focusing on what she needed for the best possible life now.

Many doctors and hospitals fear that they will lose revenue. Market purists blame the existence of insurance: We have a hard time with ‘death’ but ltting sure know a lot of euphemisms for it: The article gawand a section in which a Gunderson intensive care specialist talks about how the presence of the information elicited in discussions that occur before a crisis occurs allows much better management at the time of crisis, and in particular creates a setting in which the doctor, the patient, and the family all og an entry point for serious discussion of end of life strategies.

On docs in NYC accepting Medicare: Competition is actively discouraged. I watched her oscillate between strongly fighting the disease and wanting to make peace with her death. A sample of the fluid was drawn off with a long needle and sent for testing.

Atul Gawande: “Letting Go: What Should Medicine Do When It Can’t Save Your Life?”

Made an appointment at a big deal clinic in AZ, but suspect they may, contrary to what they told me, not qualify. A friend of mine died last year after living with a diagnosis of leukemia for a year and a half. Do you want to be resuscitated if your heart stops? Her lung cancer would almost certainly end her life long before her thyroid cancer caused any trouble.


Again that leaves plenty of time for exploration of treatment options, end of life care discussions and the execution of a living will.

The truth is that we have enough money. Related Topics Hospice and Palliative Care. Finally, I definitely agree that the Gunderson model shows that end-of-life care CAN be handeled in a compassionate and rational way, giving the patient a chance to share in the decison-making. There is almost always a long tail of possibility, however thin.

Gawande offers us useful insights on the highly complex and emotionally charged topic of end-of-life. At this moment in your life, the form asked: These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others.

The team prescribed a small dose of morphine, which immediately eased her gawandr.

Atul Gawande New Yorker Article “Letting Go”

Gunderson is another of the large multispecialty clinics in the upper midwest where values of cooperation, consultation, teamwork, and being part of a medical community are stressed over ego, independence, and mini-kingdom creation. Is Solitary Confinement Torture? Insurers who sell Medicare Advantage plans are already paid different rates in each county they do business in, along with appropriate risk adjustment payments.

The problem is not Medicare, but a shortage of primary care doctors. What was going on here? It arises from a still unresolved argument about what the function of gswande really is—what, in other words, we should and should not be paying for doctors to do. Everything else we buy, including all other types of insurance, varies by where we live and other factors.