Is the goal of modern medicine to allow one to have a good death or a good life?

Recently, I read a fascinating book called Being Mortal by Atul Gawande. You can go to www.atulgawande.com to read reviews and view videos. In short, this book elegantly addresses a conversation that is avoided, but necessary. The practice of medicine has evolved significantly and at a rapid pace. In the mist of all this development, we have lost touch with our own mortality. The fact that each organ in our body naturally ages over time, leading to system inefficiencies and degradation.

He writes:

“The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.” (Being Mortal, pg 187)

Several studies now have shown those who pursue hospice care in addition to Oncologic care when battling cancer, live longer. How could that be? Those folks had the conversation with their doctors about what is important to them. Meaning, they were able to communicate what is their personal definition of quality of life. There is something to be said about the power of our mind and soul over our longevity and quality of life. It is not surprising to hear studies that suggest good family support, laughter, constant engagement with one's community, staying active, or positive thinking enrich our lives that ultimately increase longevity and overall wellness.

For example, patients have told me, “Doc, if I cannot fish and know that I am fishing, then don’t pursue any other treatments on me.” For some it is the ability to participate in conversation or as silly as tasting and swallowing a piece of steak.

Dr. Gawande adds:

“The problem of medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet - and this is the painful paradox - we have decided that they should be the ones who largely define how we live in our waning ways. For more than a half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns.” (Atul Gawande, Being Mortal, pg. 128)

So, if death will always win this game we call life, then the practice of medicine must invest in having more discussion with our patients to find out what is most important to them. In fact, at times, doing nothing actually may result in a higher quality of life.

The challenge is that the current health system rewards procedures, treatments, and the like. It does not reward conversation. This is the fundamental problem that ultimately leads to poor outcomes in our society.

The value of good primary care is defined by its pursuit of doing whatever it can to protect and respect the patient-physician relationship. Conversation should be valued more than ordering tests and procedures. It is empowering the support system with knowledge and tools to provide high quality care to those in need.

In the end, I would argue, working diligently to preserve a full and enriching life is the ultimate goal of medicine, not battling death.

To a life full of happiness and good health,

- Dr. Ahmed