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.

Author: Gardalabar Grole
Country: Laos
Language: English (Spanish)
Genre: Finance
Published (Last): 2 January 2015
Pages: 51
PDF File Size: 2.69 Mb
ePub File Size: 20.56 Mb
ISBN: 374-6-39420-368-2
Downloads: 12834
Price: Free* [*Free Regsitration Required]
Uploader: Nikokasa

Two-thirds enrolled in hospice. People who live in the more expensive cantons pay higher insurance premiums for the same coverage than people who live in lower cost cantons. When the patient leaves the hospital, the infection may be cured, but the patient and family will need to contend with a host of major new functional and cognitive deficits. When I first learned about palliative care through the Internet it was very clear that it included the relief of pain and suffering during non-terminal illnesses.

This second, unrelated cancer was in fact operable. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. She looked as if she were drowning. They are not going to join large medical organizations; they are going to remain in small private practices doing things exactly the way they think best—the way they have always done them.

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 that information is on the chart BEFORE the patient faces serious illness.


She ate almost nothing. How long can someone live without food and water? Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. As bloggers and jouranlists write more about palliative care, the public becomes more aware, and both patients and relatives are more likely to ask about it. Palliative care and hospice are gaining acceptance, but change will take time. This works well at Gunderson partly because Gunderson is a partly closed system — as a major provider in a small city, a large number of the patients who arrive at the hospital in distress are patients who have been seen by the system before.

Ms Cox was the only one who was older at Once again, higher quality care translates into more affordable care.

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

The infection is cured but all is not well. Our team of experts answers your questions about life-threatening illness and loss. And our patients demand the lettin. The next morning, they were the ones to hold back the medical team. Nat Clin Pract Oncol. If the evidence he points to is true, then increasing access to palliative care improves outcomes while decreasing costs.

These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others.

“Letting go,” and why it’s so hard to do: Atul Gawande explores the challenges of end-of-life care

A patient with a different prognosis may have a different understanding. Everything else we buy, including all other types of insurance, varies by where we live and other factors. Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly? Considerations for a Home Death – How you can prepare to og care at home. Sure, health care is expensive.


For me, the long tail for a patient like her is three to four years. The priority was her lung cancer, I said. We have a hard time with ‘death’ but we sure know a lot of euphemisms for it: Other Memorial patients were being evacuated with help from volunteers and medical staff, including Bryant King.

And, at Gundersen, they do not steer patients away from further treatment. She had told her family on several occasions that she did not want to die in the hospital. For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light. But as Gawande suggests, the toughest issues we face turn on questions about the purpose of medicine, and, I would add, the relationship between doctor and patient.

Do you want to be resuscitated if your heart stops? The fact that we may be shortening or worsening the time we have left hardly seems to register.

As for last words, they hardly seem to exist anymore. So far, the cancer is in check.

Paul Marcoux, told her that the cancer was inoperable. Programs and Services Find local, regional, and national services. Gawande explains that expense is the reason that end-of-life medical care has become a topic of discussion.