Talking about death is hard, and many doctors aren’t very good at it:
Researchers who in the mid-1990s observed more than 9,000 seriously ill patients in five American teaching hospitals found substantial shortcomings in the care of the dying. More than a third spent at least 10 of their last days in intensive care. Among patients who remained conscious until death, half suffered moderate to severe pain. And fewer than half of their physicians knew whether or not their patients wanted to avoid cardiopulmonary resuscitation.
That’s from an interesting op-ed in the Times today by Dr. Pauline Chen. A big part of the problem is that nobody likes discussing mortal issues, especially if the dying person is your patient. As Chen notes, “Patient deaths, for many doctors, represent a kind of failure, and so without really thinking, we look the other way.”
Of course, this inability to confront the brute fact of death has huge repercussions. As I’ve noted before, 1 percent of medical patients account for nearly a quarter of all medical spending. Much of this money is spent on end-of-life care. In general, I think we need more hospices and less heart-lung machines. We don’t have to rage quite so hard against the dying of the light.
So how can doctors become better at dealing with end-of-life issues? I think part of the answer is literature. Many medical schools are now offering literature classes precisely because great novels and poems teach us how to talk about death. They give us a language to discuss the inexplicable. Perhaps future med students should find time for a little John Donne amid all their cramming for organic chemistry.