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The Best Care Possible: A Physician's…

The Best Care Possible: A Physician's Quest to Transform Care Through…

by Ira Byock MD

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Dr. Byock is the head of the department of palliative care at Dartmouth-Hitchcock Medical Center and a professor at the associated medical school. This means he has dealt with a lot of patients who are reaching the end of their lives; his job is to make that end as comfortable and stress free as possible for both them and their families. It is his contention that Americans today suffer more and die worse deaths- and more expensive deaths- than ever before. How is this possible in an age when there are so many medical treatments available?

Part of it is that the patients don’t make their wishes known via advance directives. If a person comes into a hospital without one, and they are unable to make their wishes known, the hospital has the right and obligation to do everything they can to prolong life. While this is absolutely the right thing to do most of the time, it isn’t always what the person really wants. When a person is near death from cancer, say, and takes a fall that creates a brain bleed, the hospital will put them on life support and prolong their life, even if there is no chance of recovery. Would that person have wanted that, or would they prefer to let go at that point? Who wants to live another 2 weeks if they are intubated, on a ventilator and semi-conscious at best? But doctors have an obligation to preserve life, and the family feels guilty if they say ‘pull the plug’.

Add to this problem the fact that doctors get almost no training in palliative care and end of life issues. Many don’t know the best ways to deal with pain and fear, or even how to broach the subject of impending death. Some even hesitate to prescribe opiates because they are addictive- as if that could possibly be an issue for a dying person. These things need to be addressed in medical school. Medicare adds to the problem by not paying for palliative care or hospice care if the patient is still being treated for their health problem; I know from experience that some of these treatments should NOT be considered as trying to cure the patient but rather offering a better quality to their remaining life.

This book achieved what I would have thought impossible: it’s both very difficult to read, because the subject matter is emotional and painful for someone who has dealt with end of life issues, but easy to read because of Dr. Byock’s talent with words. He includes medical details but at a level that is understandable to all; he includes details about death that don’t gross a sensitive person out. I hope that this book gets very widely read by both doctors and lay people; having gone through five deaths in our families it would have been much easier on us as family and on the patients if we’d known a lot of what is in this book way ahead of time- and if the doctors had been more comfortable dealing with end of life. ( )
  lauriebrown54 | Jun 16, 2012 |
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When someone is dying, any concerns about long-term side effects of medications of addiction to narcotic pain relievers are unwarranted.
I can say this: I have never willfully allowed a patient to die suffering. And in over thirty years of practice in hospice in palliative care, I have never found it necessary to euthanize a patient.
Allowing someone to die suffering is medically and ethically wrong.
Dr Robert Twycross, "a doctor who has never been tempted to kill a patient probably has limited clinical experience or is not able to empathize with those who suffer".
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A palliative care doctor on the front lines of hospital care illuminates one of the most important and controversial ethical issues of our time on his quest to transform care through the end of life. It is harder to die in this country than ever before. Statistics show that the vast majority of Americans would prefer to die at home, yet many of us spend our last days fearful and in pain in a healthcare system ruled by high-tech procedures and a philosophy to "fight disease and illness at all cost." Dr. Ira Byock, one of the foremost palliative-care physicians in the country, argues that end-of-life care is among the biggest national crises facing us today. In addressing the crisis, politics has trumped reason. Dr. Byock explains that to ensure the best possible care for those we love-and eventually ourselves- we must not only remake our healthcare system, we must also move past our cultural aversion to talking about death and acknowledge the fact of mortality once and for all. Dr. Byock describes what palliative care really is, and-with a doctor's compassion and insight-puts a human face on the issues by telling richly moving, heart-wrenching, and uplifting stories of real people during the most difficult moments in their lives. Byock takes us inside his busy, cutting-edge academic medical center to show what the best care at the end of life can look like and how doctors and nurses can profoundly shape the way families experience loss. Like books by Atul Gawande and Jerome Groopman, The Best Care Possible is a compelling meditation on medicine and ethics told through page-turning, life or death medical drama. It is passionate and timely, and it has the power to lead a new kind of national conversation"--Provided by publisher.… (more)

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