Ministers sometimes facilitate these conversations. This article will help me in future with that work. And, I don't need to figure out whether to bill Medicare or not.

My sister died three weeks ago after three long years of treatment for breast cancer. Her initial treatments included a double mastectomy, chemotherapy, radiation therapy, and reconstructive surgery. Then, when the cancer metastacized, she tried two more rounds of chemotherapy. Finally, during the last month, we helped her go through the final stages of her life. She died at home. She was not in any pain. She was not on any medications. There were no tubes, ventilators, or ... More »

As I proceeded through pages 1 - 8, I displayed the biases expected from my training as a family physician, noting that, as usual, Dr. Gawand, a specialist, was writing nothing about the importance of a primary care physician who knew the patient and the patient's family. On page 9, the primary care physician came in and saved the day, sort of. At least he made the end easier than it might have been. With my primary care bias, I think that the story could have been much more ... More »

I happened to be an Oncologist. I work hard to measure up to my Patient's expectation and feel great when science and compassionate, humane care go hand in hand. For example curing a young man with Testicular cancer or a young woman with Hodhkin lymphoma. Even prolonging meaningful life makes it all worthwhile.What becomes painful is having to go on with futility when patient expectations are way beyond natural history of diseases or for that matter human experience. Worst is when ... More »