Book club selection (via PJ; session held 17 June 2018).
Author finds a highly useful way to talk about a group of related, oft-discussed topics that seldom (at least in my limited experience) receive this kind of clarifying approach.
Much of the book is based on what I'll call "case studies" of folks (often but not always elderly) facing extremely poor prognoses. Including the author's father (also a physician). This served to humanize the discussion without descending into just a series of anecdotes.
Author goes through some of the background about the high expense and poor results on what has become conventional treatment for these folks - while putting them through debilitating side effects etc. How many doctors are not well trained to explore alternatives; and financial incentives are misaligned - just keep doing procedures and prescribing medications. Describes a way of thinking of doctors in three categories - paternalistic, informative, interpretive - this latter group is best prepared to engage in useful conversations with the patient and the patient's family members, rather than merely keeping up the interventions.
Author also goes through some of the history on hospitals; the rise of nursing homes; the rise of assisted care centers; hospice.
The most useful part of the book is the ideas about how (and when) to engage in critical discussions with the patient - questions such as "What are your goals? Where is your "line in the sand" when it comes to deciding how you want to live in your last weeks and months?" We need to be thinking and talking about this for the sake of our family members, and for our own sake. With a more fulsome discussion - alternatives like hospice often start to make more sense.
This led to a quite interesting discussion during the actual "club" meeting - while most of our members are relatively young, everyone has faced up to this with relatives, many quite poignantly.
Recommended.
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