Pauline W. Chen: A Surgeon's Reflections

Talking Often, and Calmly, About Dying

This week, end-of-life care discussions joined the political debate over health care reform. What started out as legislative proposals to finance optional end-of-life care consultations between doctors and patients morphed into governmental bodies (so-called "death panels") that would decide which dying patients would and would not receive care based on cost-cutting measures. False assertions and rumors resulted in debates so ferocious that even well-seasoned health care advocates were taken aback.

As someone who has written an entire book about the difficulties of caring well for the dying, I find all the fury aimed at halting support of end-of-life care discussions more than a little ironic.  Why? Because the truth is that most of us need all the help we can get to start these difficult conversations. The truth is that we never talk or even want to think about talking about dying because we are afraid of dashing the hopes of our loved ones or our patients. The truth is that we fear -- even abhor -- these discussions because we believe that by talking about dying we are giving up.

Yet all of those imagined fears could not be farther from the reality of end-of-life care discussions. At least according to some of the best research on the impact of these conversations on patients and their loved ones.

In this week's "Doctor and Patient" column, I speak with Dr. Holly Prigerson, one of the country's leading researchers on end-of-life care discussions, and ask her about the significant and enduring effects of these conversations on patients and their families. 

Have you, as a patient, friend, family member or doctor, participated in end-of-life care discussions? Were they difficult? Did they make a difference? And do you believe they should be supported in legislative proposals for health care reform?

Please leave your comments below or in Tara Parker-Pope's "Well" blog.

Are Patients in Part to Blame When Doctors Miss the Diagnosis?

    This week in "Doctor and Patient," I write about an increasingly popular topic of research in patient safety: diagnostic failures, or diagnoses that are delayed or in error. While some researchers have focused on the role of doctors -- are there flaws in the way they think? Are gut reactions reliable? -- others have looked at the steps involved in care. What has emerged  most recently from this latter group of studies is that diagnostic failures are often due to missed steps, so-called "process of care lapses," that stem from both doctors and patients.

    Have you, as a patient, doctor, or both, experienced a process of care lapse that led to a missed or late diagnosis? Who is ultimately responsible for diagnostic failures and how can we decrease them? Please leave your comments below or in Tara Parker-Pope's "Well" blog.