Atul Gawande: recommendation

Transcript context

…The famous late 19th-century doctor, William Osler, he once said—here’s the quotation: “Look wise, say nothing, and grunt. Speech was given to conceal thought.” True or false? False, but there’s a grain of truth. One of the things that I learned in writing my last book, Being Mortal, was talking to palliative care clinicians and geriatricians and others who really have a different kind of approach to practice. Examining the way I practice, what they would say I do is talk too much, and as one put it, “Your problem, Atul, is that you’re an explainaholic.” Our model of what a clinician does is that they are Dr. Informative. They give you data about what condition you have, data about the options. Here are the option A, option B, option C. Risks, benefits, pros, cons, and now what would you like to do? It’s a conversation where we do 95 percent of the talking, and then the patient does 5 percent. What they point out is that they, the clinicians of the future, really need to be oriented in a counselor mode, where they are not just telling you what the options are, but also eliciting from you very clearly what your goals are, and then making a recommendation about what most matches your goals. What are your priorities for your quality of life as well as quantity of life? People have priorities besides mere survival. When we don’t ask and don’t know how to ask what those priorities are, the treatment is often mismatched with those priorities, and that’s where you get suffering, and that’s where you get lots of hot air from doctors, and you have total misalignment. When you are able to elicit those goals and then align the care with it, you have massively better outcomes, both for quantity and quality of life. Do you ever worry that doctors become corrupted by their own authority? Not corrupted in the sense of taking bribes, but they have such authority, people look up to them. They say “Take off your clothes, sit on the table.” People do it—people are in the mode of obeying. A lot of patients, frankly, are probably a pain, so doctors in a sense can manipulate patients to make each interaction easier because they’re such high-status figures. And then doctors fall into this mode of being used to doing that with people in general. What do you think are the main psychological dangers of corruption that can stem from being a doctor and having such high status? Control over life or death. “You can cure people, the gods cannot.” That’s what Sir Thomas Browne said, right?…

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