Brooke Zwick - Teen Aspect - July 17th, 2022
Joy Sessa, Ph.D., a field representative for The Joint Commission, recommended a book to me. A physician at a hospital she had recently reviewed had suggested it. When she started to describe the book, I was hesitant to read it, due to the fact that death and dying was the subject. However, my perspective shifted as I read the book which left me with many questions. One of those questions was: How do we treat end-of-life as a society and how can we improve?
The book, “Being Mortal: Medicine and What Matters in the End” by Atul Gawande (i) , highlights the challenges of aging and dying in the United States. According to an article published by Robert H. Shmerling of Harvard Health Publishing, over 700,000 people in the United States die each year in hospitals (ii). The question is: how prepared are healthcare workers, including physicians, to help their patients navigate this final chapter? Because American culture has treated aging and death as medical problems to be solved, it has led to conflicting priorities within medicine. Patients and families struggle to cope with the process that is both frightening and unfamiliar. Physicians, trained in the medical science of preserving life, may find end-of-life conversations difficult.
This raises another question: how prepared are physicians to deal with death? During medical school, students in the United States are grossly unprepared to deal with a patient's death. From a telephone survey of 1,455 students and 296 residents, less than 18% of students received formal end-of-life care education. As for the residents, over 40% felt unprepared to teach end-of-life care. Of those same students, 39% felt unprepared to deal with the death of patients (iii). The beginning of handling end-of-life care and conversation begins with educators. Part of caring for patients includes developing the skills to conduct end-of-life and palliative care conversations with both patients and their families.
The numbers show that recently more patients that are terminally ill or elderly choose to die at home. A study from Stanford’s School Of Medicine shows that 80% of Americans prefer to die at home (iv). This may reflect the inadequacy of modern medicine in matters of death and dying.
The problem is not confined to physicians. There is room for growth concerning the public’s knowledge about end-of-life. Allowing conversations about death and dying can help us be prepared to support a loved one who is going through the process themselves. Even through this potentially uncomfortable topic, we can change our perspective on how to treat someone who is aging and/or dying. It’s important for everyone to be educated, with the hope that there will be less avoidance around the subject in the future and more advocacy for open conversations on end-of-life care by people of all ages.
(i) Gawande, A. (2017). Being mortal: Medicine and what matters in the end. Large Print Press, a part of Gale, Cengage Learning.
(ii) Robert H. Shmerling, M. D. (2018, October 31). Where people die. Harvard Health. Retrieved July 12, 2022, from https://www.health.harvard.edu/blog/where-people-die-2018103115278
(iii) Sullivan, A. M., Lakoma, M. D., & Block, S. D. (2003, September). The status of medical education in end-of-life care: A national report. Journal of general internal medicine. Retrieved July 12, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494921/
(iv) Where do Americans die? Multicultural Palliative Care Portal. (2013, April 21). Retrieved July 12, 2022, from https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/