End of Life: What Matters

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In his book Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande, discusses a current failing of the health care system, which is the lack of emphasis and training in the geriatric field and End of Life care. Dr. Gawande, a public health researcher and surgeon at Brigham and Women’s Hospital, recounts personal experiences with his patients detailing the challenging and often distressing situations they’ve encountered in nursing home environments. He underscores the systematic impediments that abrade the processes in this critical phase of care. Consider these statistics Dr. Gawande cited in a recent interview:

  • Geriatric training is virtually absent from medical school
  • Fewer geriatricians are trained than 10 years ago
  • 97% of med students have no training
  • 17% of patients die at home; 83% in institutions

Looking at these numbers in a larger context, Dr. Gawande stresses the importance of geriatric proficiency within the medical community; the choices available to people who are approaching the end of life; maintaining one’s autonomy when making tough decisions; and expresses concern about substituting frank discussions about death with traditional courses of treatment: “Doctors, uncomfortable discussing patients’ anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them.” Following the daily rounds of a hospice nurse and geriatrician, Dr. Gawande offers insightful perspective on the current flaws of the system and actions to be taken by both doctors and patients to improve their end of life journey.

Valerio Care Management shares in Dr. Gawande’s platform of quality care. End of life should not be distressing, but an enriching process. As a veteran social worker and care manager, I understand the systematic lapses he talks about, and how that ultimately impacts a person’s well being when faced with critical choices. I want clients to have an active role in decision-making and preserve their autonomy. Being their advocate has always been the driving factor of VCM. Looking ahead, I hope to share with others in our mission in providing solutions to these existing challenges.



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