February 19, 2020
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4 basic questions this surgeon learned to ask patients nearing death, and why they matter

Tim Llewellyn | BDN
Tim Llewellyn | BDN
Atul Gawande.

Atul Gawande is a surgeon, professor, public health expert and staff writer for “The New Yorker” magazine who has also written several best-selling books. He came to Maine recently to give the keynote address for the annual conference of Maine Quality Counts, a nonprofit collaborative seeking to improve the quality of the state’s health care.

Physicians have gained incredible knowledge over the last several decades but are still struggling to ensure everyone benefits from that science and discovery, he said. The increase in health care costs has not corresponded to an increase in quality.

As Gawande said:

“There is more and more evidence that there is a wide bell curve in the health and quality of care that people receive depending on where they go for their care and where they live. And most of us as patients are grouped in the mediocre middle. We’re not getting the very best results. …

“Then you add to it that there is a wide bell curve for costs for how much is spent, and the startling thing is that the two curves don’t match. The most expensive places for care in the country are not the places getting the best results. There’s no clear correlation on the curve we exist on in the United States. In fact many of the best places are among the lowest cost.

“And I’ll tell you that’s another reason why I’ve really always loved coming here, is Maine is one of those places. It’s a place where in Medicare you’re in the top quarter of the best outcomes and results at least as far as we can measure them, and the lowest quarter of Medicare costs.”

He also discussed end-of-life care, explaining how he discovered a few basic questions to improve his conversations with patients:

— What is your understanding of where you are with your health?

— What are your fears?

— What are your goals and priorities?

— What are you willing to sacrifice and not sacrifice for the sake of gaining more time?

“People have priorities besides just living longer in their life,” he said.

He went on to describe his own father’s answers to those questions as his father neared the end of his life.

“Then the puzzle is what really matters to you? And if what matters is learning how to keep independent, how to maintain a quality of life that they define, and that we fight for that with all of our capabilities, that can lead to a re-orientation,” he said.

Please watch the full video by clicking here.

 


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