Being Mortal: How to Have the Difficult Discussions

02. January 2018 TIPS & TRICKS 0
Being Mortal: How to Have the Difficult Discussions

Reading Being Mortal by Atul Gawande has been an incredible experience. As he copes with the loss of his father, Atul Gawande explores what we do wrong when we approach end of life decision making for terminally ill patients. I was immeasurably touched and immensely grateful that he bared his wounds to the world, in attempts to teach us all a thing or two about how to become better physicians. Technological advances in medicine have created more options than ever before, and this certainly isn’t without its challenges. We run the risk of causing more damage than healing. “Doctors, uncomfortable discussing patients’ anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them. And families go along with all of it.” As he puts it, “the power of medicine will always remain finite”. Our role as physicians is not simply to ensure health and survival with our toolbox of treatments, but to enable well-being.

Dr. Gawande shares with us his pearls of wisdom, a series of questions that are necessary to ask in order to understand the patient’s wishes, and adapt their care accordingly. To do justice by our patients is to create a safe space where these questions my be addressed freely, without coercion, judgement, or input from our personal biases. Let us shed any hint of paternalism, and avoid overwhelming our patients with statistics and lists of what our toolbox has to offer. Instead, let us make our patients feel truly heard and understood by engaging them in a discussion of what is important and valuable to them. Only then can we comprehend what we can offer as physicians, in order to respect these desires. Only then, can we truly do our patients justice at the most vulnerable time of their life.

Whenever a serious, irreversible sickness or injury strikes and the body breaks down, these questions are vital:

  1. What is your understanding of the situation and its potential outcomes? I cannot tell you how many times I’ve walked into a room, and a patient with metastatic cancer has not been made to understand that there is no cure… only ways to buy time with the best quality of life we can achieve.
  2. What are your fears and what are your hopes? 
  3. What are the trade-offs you are willing to make and not willing to make? 
  4. What is the best course of action that serves this understanding? 

In no way will these discussions be easy. However, all it takes is one discussion to shape how this person and his/her family will experience their death. That, is one powerful discussion.

As life approaches its end, we all have the need to “share memories with our loved ones, pass on wisdoms, settle relationships, establish our legacies, ensure that those left behind will be okay”, and perhaps more importantly, grow ever closer to our Creator in so doing. Imagine if, as physicians, we are able to mobilize the teams and apply the treatment approaches necessary to grant this to each and every single one of our terminally ill patients, no matter our specialty. Now that, is a powerful idea we should aspire to make a reality.



Gawande, Atul. Being mortal. Anchor Canada, 2017.