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. Author(s): Atul Gawande. Url: Publisher: The New Yorker. Year: Description: Article written by a.

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I do agree that, when it comes to end-of-life issues, I tend to focus on the individual rather than the larger cost to society. I find waiting times are usually quite short in the offices of Park Avenue specialists. These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. As to why this is not applied more widely: Gawande ends his story with great humility, describing the scene, last winter, when he tried to tell a patient suffering from colon cancer that she was dying.

Rather, as Gunderson has shown, they can serve as a valuable jumping off point to initiate a discussion that is difficult for providers, patients, and families.

“Letting Go” – The New Yorker’s Atul Gawande, on giving up life to live –

Proscription on Antiperspirant Use During Radiotherapy: Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly? It would be best if doctors begin talking to patients about options before they fall ill—recording what they say on their chart. Ye t gawand the spending begins, no one knows which patients will survive.

You and I may think we have given the issue of end-of-life care a great deal of thought—and we have. As for fiscal trends that are unaffordable—they have continued for a very long time—and may well continue, taking the country down og them. I suspect another factory farm health care institution. Two-thirds of the terminal-cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death.


Two-thirds enrolled in hospice. Here are links to short articles on 1 negotiating the difficult transition to hospice care and on 2 balancing hope and acceptance at the end-of-life. The folks at Gunderson figured out how to bring true shared decision making to aful of life care. Leave a Reply Cancel reply. Sure, health care is expensive. July 29, at 3: If NYC residents had to pay twice as much for their Part B benefits as people in La Crosse, WI, they might start to ask their doctors why costs here are so much higher when outcomes are no better and in some ways worse.

First, aim for better care. According to the Swiss expert, many of their hospitals resemble five star hotels and the overall structural healthcare infrastructure goo quite high in quality. And, 6 months after they died, their caregivers were three times as likely to suffer major depression.

The lesson seems almost Zen: They save their petting for a good death. A lot has been said about the high cost of end of life care, and a lot of emphasis has been placed on the cost savings that could result in forgoing that care. Because the answers are then in the hospital chart, it can then serve as an opening for further discussion.

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

I assume patients with a terminal illness would have different attitudes towards palliative care depending on their state of mind. But, either way, they received phone calls from palliative-care nurses who offered to check in regularly and help them find services for anything from pain control to making out a living will.

Two-thirds enrolled in hospice. She had a right to know. The whole point of the questions — and from what I read in the article it sounds like they are not a questionnaire but rather a guideline for providers to initiate the discussion of life support management — is that lettjng information is on the chart BEFORE the patient faces serious illness.


The firefighter was So while persuading people to sign end-of-life direcives while they are still healthy could gxwande a very useful conversation, we have to realize that when they become sick, those directives may change.

Clearly not a representative sample of the dying folks in America. Demagogues shout about rationing and death panels. Moreover, the curve was skewed to the right, with a long tail, however slender, of patients who lived many years gawznde than the eight-month median.

Besides, how do you attend to the thoughts lettkng concerns of the dying when medicine has made it almost impossible to be sure who the dying even are? Palliative care and hospice are gaining acceptance, but change will take time. Over-all costs fell by almost a quarter.

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

But the third who did were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive-care unit. This sounds suspicious, but it was passed on in a matter of fact manner. We save money and spare patients and their famlies needless suffering. He or she is in control; the patient makes the final decisions; the patient is not in pain. People in high cost locales earn higher nominal dollar wages and ultimately receive higher nominal dollar social security benefits than those who did similar work in lower cost regions.

We fall back on the default, and the default is: It could be that stories of dying young people are much more Hope is not a plan, but hope is our plan.

If the pilot is succesful, Medicare could roll it out nationwide, without needing approval from Congress. The patients were not clustered around the median survival but, instead, fanned out in both directions.