cal Association’s annual policymak- ing and educational meeting, TexMed 2015, in May.
“We haven’t yet made one person immortal. At some point in time, more disease treatment does not equate to better care.”
Texas Medicine: As an expert in end- of-life care, you call this this one of the biggest national crises of our day. What do you mean?
Dr. Byock: The Institute of Medi- cine (IOM) report Dying in America, released in September, was a com- prehensive critique of what is a true public health crisis that persists in America. The institute’s report could legitimately have been called Dy- ing Badly in America because it once again details systemic deficiencies and problems in medical education, in medical practice, in the way health care is financed, in the staffing of long- term care and home health care, and basically in our cultural approach to serious illness and dying. At 18 per- cent of the gross domestic product, we Americans are not getting a good return on our investment. Many Euro- pean countries are spending much less and getting measurably higher quality care. Nowhere is this gap more appar- ent than when it comes to serious, in- curable illness, and the experience of dying patients and their families. After three decades of progress in hospice and palliative medicine — although we have yet to transform the health care system — we have demonstrated that much better care is both feasible and affordable. I’m on the road, and I spend time at my computer writing opinion pieces and academic articles because I know this is one national crisis we can solve.
Texas Medicine: What makes this a crisis?
Dr. Byock: People are dying badly. People are dying in ways they would
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not have wanted, in places they would not have wanted to die if anyone had asked them. But of course, we don’t ask them. Now let me just say, this cri- sis is unnecessary, and it can be fixed. But there are no villains here. We have all grown up in traditions and with at- titudes and assumptions that are not serving us in these unprecedented times. And physicians are so well- positioned to assert not only clinical leadership, but also cultural leader- ship. We’ve yet to make even one per- son immortal, so our commitment to excellence and giving the best care possible to each and every patient has to extend to making sure that their comfort and quality of life is as good as it can be, that their family is as well- supported as they can be, on their own terms.
Texas Medicine: What do you con- sider the “best care possible”?
Dr. Byock: I realized 30 years ago that was the one thing I could be sure of that every single person I met wanted for himself or herself and for those they love. What that meant was unique to each person, but I began to realize there was a way of discern- ing what the best care possible meant to each person at each point in time. And it became my role as a physician to help them do that. So while the best care possible is not a one-size-fits-all model, there is a way for physicians working with patients and families to clarify what that is at any given point in time.
Texas Medicine: How so? What is doctors’ role in that conversation?
Dr. Byock: As physicians, we bring our medical expertise to healing inju- ries and fighting disease and prolong- ing life, and that’s as it should be. But
IOM report Dying in America: tma.tips/IOMDyinginAmerica
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