When Less Care is More

Doctors are trained to try to figure out what’s wrong and fix it.  We’re trained to make a plan and execute it, to do something.  But that impulse to order the next test, prescribe the next therapy or do the next procedure can harm our patients if it’s done without consideration of the patient’s goals.  That’s particularly true with older frail patients whose quality of life is decreasing.  In our reflexive rush from symptom to test result to treatment, we may never stop to think that the treatment may cause as much harm as good, and that the benefit we hope for is unrealistic.

This week the NY Times had an important article about a geriatric program that educates patients and their families and puts their goals first.  The program is called “slow medicine” because at each step there is time for questions, answers and deliberation.  With this perspective a futile hospitalization may be avoided, a surgery that is unlikely to impact the patient’s overall course may be refused, a loved one’s wishes about her last days may be honored.

If you are caring for a loved one who is in the last chapters of his life, I urge you to read the article.

Doctors need to relearn that life-saving is only temporary and that comfort is sometimes the best treatment we can offer.  Families and patients need to learn to ask difficult questions and to find doctors who will answer them.

(Thanks to Dr. Mark Urman and to Andrea G. for bringing the article to my attention.)

Learn More:

New York Times article:  For the Elderly, Being Heard about Life’s End

Tangential Miscellany:

Happy Mother’s Day to all the moms out there!  Thank you for the years of sacrifice, work and worry.

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