Tuesday, February 23, 2016

Book review

So, on the advice of my new medical director, I read another book from Atul Gawande. This one was called, Being Mortal: Medicine and What Matters Most in the End. It is a very good book and should provoke anyone reading it several times. It does overlap with my new gig, which will be in palliative care and of course that means it also crosses with hospice care. Still, that is not really the main thrust of the work. In the business world, fads come and go. We've all seen them. How to talk to customers, How to gain customers trust and on and on. From day one of my new career as a nurse, I've been annoyed at that presence in medicine. And for ten years, I've sat through a lot of truly boring and useless customer service trainings. These trainings had nothing to do with improving patient care, but taught us how to kiss ass so that we used buzz words in our dialogues with families in order to get them to fill out a survey that would make us look good t Medicare. Unfortunately, we are still in that mindset.

Gawande highlights what has been an ages long problem, which is that as seniors age and lose physical ability and independence, we basically punish them in the name of safety. Letting them keep more independence inevitably will lead to more incidence of falls and increased risk for injury. BUT, it also helps seniors maintain a sense of humanity and happiness. He highlights several pioneers who created REAL, GENUINE assisted living wherein seniors had their own room, a lock on the door, ability to cook and freedom to go to bed whenever they want and get up whenever they want. These homes had stunningly good results of providing a way for seniors to maintain as much independence for as long as possible, and predictably, they look nothing like a nursing home when you get in them. As mentioned though, with that increased freedom comes some increased risk, and falls and injuries do happen, and families struggle with this. They know their parents are miserable without independence, but the children want what makes THEM feel safer and hence, they begin trading their parents freedom for safety to the point that their parents are basically strapped into a wheelchair unable to do anything they love. Despite the proof these homes achieved the goal of providing autonomy, the financers and fucking wall street types completely perverted the idea to where it is now basically just a rip off of a name that has little to no connection to the original idea. But it makes money.

But, he also talks about, again, the difficulty doctors have with 1) leveling with people and 2) taking time to figure out what is important to the patient. We ass kiss a plenty these days, and we makes the facilities "pop" and look all modern so that when families walk in, they say, "Oh, this looks so nice", and that's the point. It's bout the family, and not the patient. He goes back to a framework several times that he said was painstaking for him to learn, but I hope this will be the foundation of what I do as an NP. What is your understanding of the situation and it's potential outcomes? What are your fears, what are your hopes? What are your trade offs you are willing to make and not willing to make? What is the course of action that best serves this understanding? Midway through the book, he starts to transition to focusing on how these questions affected him and his family and several patients he cared for. It does cover things I've kinda preached about here before, but goes further. Right now, for the boomer generation, I believe we are woefully unprepared to take care of the aging and passing of this generation. It's one thing to hate Obamacare, but I think all of you in that boomer demo should give this book a look to shape your thinking on what you want your future to look like. Believe me, not a single candidate in the running is addressing anything talked about in this book. 

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