Medicine today focuses on the diagnostic and clinical care for the terminally ill when more emphasis should be placed on their comfort and care. Everyone imagines that they will have a long, full life with; plenty of time to achieve their goals and dreams. Even the best laid out plans can get detoured. We often think of terminal illness as happening to others, certainly not to ourselves. Atul Gawande showed us through his article “Letting Go” http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande that the initial response to an unfavorable prognosis is to “fight.”
With all of today’s medical advances we tend to believe that there is a cure for most diseases, or there may be one in our life time. This belief combined with our fear of dying makes it so easy to believe that an untimely death could or could not happen to us. Just because we can sustain life through medical interventions, medications, IV tubes, respirators and ventilators, the fact remains that these interventions and side effects are often worse than the disease, not giving you the quality of life. It is a balancing act for the doctors as they must be encouraging along with being realistic. They need to talk about what to hope for while also discussing how to prepare in case it doesn’t work out.
If communication skills were taught and practiced as much as technical skills in medical schools, there would be a huge improvement in patient care. Doctors need to help the patient decide what is most important to them when they are dying and then work towards achieving the patient’s goals. Ideally every terminally ill patient should be connected to a trained caregiver. This would help the patient learn more about their options, deal with anxieties such as being a burden to love ones, financial problems, pain and suffering, and ultimately their death.
A balance must be found that combines life prolonging treatment along with palliative care. Patients need to be informed that they don’t have to choose one over the other. This would lower overall costs and mean fewer visits to the emergency room and decrease the time spent in the hospital. The sooner these issues are addressed the sooner the patients will feel more in control of their situation leading to a more peaceful death. Medicine should be about comfort and care, not solely focused on cure.