Up@dawn 2.0

Tuesday, December 16, 2014

Why Do Doctors Fail?

One of our upcoming authors in Bioethics next semester, Atul Gawande (Being Mortal), has joined distinguished company - Bertrand Russell, Arnold Toynbee, Robert Oppenheimer, and J.K. Galbreath et al - with his Reith Lectures, commencing with "Why Do Doctors Fail?"

Surgeon and writer Atul Gawande explores the nature of fallibility and suggests that preventing avoidable mistakes is a key challenge for the future of medicine.
Through the story of a life-threatening condition which affected his own baby son, Dr. Gawande suggests that the medical profession needs to understand how best to deploy the enormous arsenal of knowledge which it has acquired. And his challenge for global health is to address the inequalities in access to resources and expertise both within and between countries.
This first of four lectures was recorded before an audience at the John F Kennedy Presidential Library and Museum in Dr. Gawande's home town of Boston in Massachusetts. The other lectures are recorded in London, Edinburgh and Delhi.
Previous Reith Lectures

NY Review of Books (@nybooks)
Marcia Angell on getting old, and on choosing when to die j.mp/1wbDL6v

Our bodies age. As members of the kingdom of animals, we inherit a biology that grows less efficient with time. Glitches and injuries accumulate. Our youthful form is lost, and our aged one is gained.
By dint of fear of change, the innate sexual attractiveness of younger bodies, and massive exploitation of both by marketing forces, we feel embarrassed and deprived as our bodies slowly deteriorate.
Not all cultures view aging so negatively. So the bias could be overcome. But how?
  1. Don’t take aging personally. After all, aging happens to everyone, from the beginning of life until its end. And like they say, Growing old beats the alternative! Every person who has ever lived beyond early adulthood has grappled with the changes the years impose. Granted, some people age more slowly than others, but every one of us looks and feels older as time passes. You are not alone.
  2. See aging as Natural. We live in an era when ‘organic,’ ‘all-natural,’ ‘non-GMO,’ ‘cage-free,’ and other eco-marketing catchphrases are used to sell products. Moderns want the growth and harvesting of foodstuffs to proceed naturally. Well, aging is no less aligned with Nature than vegetables cultivated without pesticides; why not embrace growing older the way we embrace organic foods?
  3. Appreciate the gifts of aging. As we grow older, we grow wiser. This isn’t folk mythology; it’s fact. We learn from experience. We find more acceptance in our hearts. We assess our strengths and weakness with more humility and self-compassion. We begin to view circumstances in shades of gray rather than black-and-white. Youthful hunger wanes until we find ourselves valuing what matters over the long run above what feels pleasant in the short run. We care less about personal goals and more about collective ones. To my mind, at least, the gain of gentleness, nuance, and altruism more than compensate for the lessening of passion and militance.
  4. Embrace the big picture. If you listed the names of all 108 billion people who have ever lived, at the rate of one per second, it would take 3,400 years. And the entire human saga has unfolded over just the last 0.005% of the time since life began on this planet. Does it make sense to feel affronted by a body’s aging when so many people (and countless other lifeforms) have endured the same fate, and when the span of even the longest human life barely measures as a single tick on the cosmic clock? Each of us is a unique product of history, but we delude ourselves if we believe our own lives more important than those of all the others. If we identify with Life as it has grown on this planet for billions of years, rather than our personal speck of biology, we gain freedom from the constrictions of daily concerns. We feel opened to a larger world, a larger sense of Self, and the great, beautiful mystery that is Living.
  5. Nurture a sense of humor. It helps to take aging less seriously. Early in 2014 I underwent major surgery. Postoperatively, I was horrified to see how the abdominal muscles I’d been strengthening for years ended up looking scarred and distorted. It helped lessen the sense of grief when I joked about losing my ‘last bastion of sexiness.’ The use of humor has a long history of helping the aged feel less burdened by wrinkles, sags, dribbles, creaks, and farts. Join the fun!
Being Mortal, which was published in October, is ostensibly about the struggle to cope with the constraints imposed by flesh-and-bone biology—and the failure of medical science to acknowledge that any ability to push back is finite. Gawande's ultimate message, that death in America is not often enough discussed, and that patients suffer at the hands of well-meaning doctors because of it, has been generally celebrated, though not for breaking particularly new ground. His is the basic message for which the late surgeon Sherwin Nuland's How We Diewon a National Book Award 20 years ago; and it's the message of another book released last week, The Conversation, by another Harvard physician, Angelo Volandes. It's a message that has grown extremely loud inside of the health-professional echo chamber, but is somehow still only faintly reverberating into broader culture. 
"I think too many people don't know what's going on behind those closed doors in hospitals," Volandes told me. "But if they did, they'd be outraged. So many people are getting—not costly care—I'm talking about unwanted care..." (continues) 

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