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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So, while it may not be appropriate to start an end of life discussion with ltting who shows up at the ER with a severe stroke, the Gunderson model can work perfectly well in the overwhelming majority of end of life cases, most of which involve elderly people.

Given the extent of the surgery that would have been required, and the potential complications, the best course was to do nothing. Everything else we buy, including taul other types of insurance, varies by where we live and other factors. 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.

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

He wanted to make it clear that these doctors were not making a straightforward medical judgment but, rather, a moral judgment that people like Matthew were so devastated that they had lost their claim on existence. I gadande the following points noteworthy: One thing that struck me was how young patients were.

She looked as if she were drowning.

But our responsibility, in medicine, is to deal with human beings as they are. July 29, at 3: This oetting, unrelated cancer was in fact operable. And once someone is very ill, handing them a directive to fill out seems to me a pretty abrupt way to start the conversation. I think one approach we should consider is to have beneficiaries pay a Part B premium that varies by the county that they live in.


The fact that we may be shortening or worsening the time we have left hardly seems to register.

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. In La Cross and at Gundersen, at the end of the day, end of life care costs a bit more than half of the national average. Ultimately, Gawande suggests, the problem with the way we deal with death today is that we have forgotten the art of dying. It more or less did to me, until I actually had a chance to see what hospice was.

To enroll, she would need to wait two months, in order to get far enough past the episode. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.

Costs of cancer care in the USA: It could be random, it could be Dr Gawande’s practice. Their approach should ztul widely copied and regional differences in end of life medical outcomes should be widely publicized. Ye t when the spending begins, no one knows which patients will survive.

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

This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function see GeriPal write up here. What can I do to support my wife who’s dying and let her know she won’t be forgotten?

We imagine that we can wait until the doctors tell us that there is nothing more they can do. They remain riven by doubt and fear and desperation; some are deluded by a fantasy gqwande what medical science can achieve. And brand-name specialists continue to take Medicare. I watched her oscillate between strongly fighting the disease and wanting to make peace with her death. But what happens to those who survive their hospitalization for severe sepsis?


This requires as much listening as talking. So while persuading people to sign end-of-life direcives while they are still healthy could start a very useful conversation, we have to realize that when they become sick, those directives may change. It would be best if doctors begin talking to patients about options before they fall ill—recording what they say on their chart.

My guess is that with supportive hospice therapy, patient are no longer flailing about, they are no longer wrestling with the Angel of Death. How can I support my husband who’s been diagnosed with cancer and is waiting for test results?

As for the rigidity of medical cultures, I recommend transparency around the combination of medical outcomes and resource utilization. The mother of one colleague who recently moved to NYC from NJ called eight different doctors in an attempt to find a primary care doctor who accepted Medicare.

All this is just another way arul which our love affair with high tech medicine has prevented us from offering better and more appropriate care and harmed gawanre as well as the economy.

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

She has done well. I have had this conversation with more than one Park Avenue specialist. But the vast majority of primary care docs are not taking new patients period—whatever insurance you have. She ate almost nothing.