This post is not going to teach you anything – it’s a book recommendation. I know you might be thinking ‘when do I have time to read a (non textbook) book?’ but stick with me.
I came to read this book, not through selecting it myself but it was gifted to myself, along with a copy for all the doctors in our practice, by a patient. So, I added it to my growing pile of books to read. I tend to save books for holidays because I am an avid reader – one that struggles to read just a few pages at a time. But I knew I would read it. If someone has taken the time to gift you a book then it’s got to be worth a read.
I wasn’t entirely sure what the book would cover, since I hadn’t read the Amazon synopsis in advance. So to convince you it’s worth your time I will give you a rough idea, and place it into the context of why it was a great read for me.
The book covers the issue of death, and how we get there. Atul Gawande is a surgeon in the USA, and he wrote this book after reflecting on his experience of caring for older people – professionally and personally, and looking after those with terminal diagnoses. It is a personal reflection of his journey to improving the care of those people in the later stages of their life, and in the terminal phase. He looks at ageing (briefly), and how that impacts upon physical ability. Then puts this into the context of care of older people – in hospital and beyond. He looks at how modern medicine impacts upon mortality, and the choices available to people of all ages when they are given an end of life diagnosis. Finally, then looking at the change from managing at home to needing nursing home care, and how this has changed with time. He has spoken to palliative care specialists, those who have worked within the social care setting, colleagues, and most importantly patients.
All of the above is why I urge you to read this. How many of you have spent much time in your medical education and work, to date, dealing with end of life care directly? I recall my time as a trainee in the hospital recognising that people were moving into the terminal phase of my life, but not having the seniority to ‘make the call’. Sometimes I’d be given the responsibility of having discussions with relatives, to pass on the decisions made by senior colleagues. Sometimes I would watch as colleagues made seemingly unfathomable decisions that we must continue aggressive treatment of patients. I actually found some of my hospital shifts extremely upsetting as a result of this. I felt helpless watching management plans unfold, and being complicit in seemingly irrational management plans. The hospital is a busy place, and often understaffed at weekends. This could lead to a more senior doctor not having time to review your patient, and thus see in reality their situation. As such this sometimes seemed to prompt them to make management plans that would serve as a ‘holding plan’ until they could get to see the patient. My issue with this process was that by undertaking and ABG, or a portable CXR, you are suggesting to the family members who are watching their relative get sicker, that there is a way back from this. Yes, sometimes this is the case, but in one particular experience (I recall the scenario vividly – it happened 7 years ago) I knew that they would make no difference, but I followed orders. I remember thinking at the time I would rather spend my time talking to the family, and making this death something they wouldn’t remember as traumatic in any way. I didn’t get to do that. I felt really unsatisfied with my job when I got home that day.
This book, didn’t solve anything for me, but it made me think of how it could help hospital colleagues. It made me consider how I could potentially help my patients avoid being in this position when they reach the hospital. It opened up the idea of very frank and honest discussions. I thought I was trying to do that already, but this book gave me some tips on how to refine this.
It didn’t take too long to read. I also found there was no part of the book that I felt the urge to skim read. It was all interesting, and pertinent to the role of a GP. I encourage you to read this book, because I think it will improve your care of those patients reaching the later phase of their life, and making that time a positive experience for themselves and their family.
You can find a link to the authors website, and more information on the book here
The GP trainee's survival guide 