The True Art of Medicine: Atul Gawande and The Being Mortal Documentary

by: Stephanie E. Rogers, MD @SERogersMD

“The two big unfixables are aging and dying…you can’t fix those,” notes physician-writer Dr. Atul Gawande, in a new documentary based on his recent book Being Mortal. The Frontline documentary airs Tuesday, February 10 on PBS, and explores Gawande’s frustration of not being able to “fix” all of his patients.

The Being Mortal documentary examines how Gawande and other physicians struggle to talk with patients and families about death and dying. He explores his own humble journey with the realization that “medicine fails the people it’s supposed to help” at the end of life. It also provides a powerful, intimate look at families struggling with conversations about the realities of aging and death, and the uncomfortable and difficult time even well-trained physicians have at leading these discussions.

One of the most startling aspects of the documentary is watching physicians participate in these conversations with patients and the behind the scenes look at what their thoughts are regarding these discussions. Even with cancer physicians who have these conversations all the time, it is apparent that they too are struggling to be forthright and eloquent. In fact, this is what makes Gawande a skillful storyteller- he exposes his own vulnerabilities both as a physician trying not to be the bearer of bad news and as a patient’s family member during his father’s inevitable death from a spinal cord tumor.

“Hope is not a plan,” Dr. Gawande argues. “We find from our trials that we are literally inflicting therapies on people that shorten their lives and increase their suffering, due to an inability to come to good decisions.” He notes that people may have other priorities besides living longer and that we should not be waiting until the last week of life to have these discussions with our patients.

As a Geriatrics fellow, I have learned that speaking to patients frankly about aging, dying, and their priorities for the time they have left has been the toughest challenge I’ve encountered yet in my decade of medical training. We physicians tend to be overly optimistic and timid about the truth, partly because it is difficult to tell a patient something they don’t want to hear. We want to instill confidence in our patients and hope with them for a cure or more time.

I now realize that the most worthy challenge– one likely to last my entire career – is to improve my ability to have these conversations. Our decisive goal as physicians is not only to know the most up-to-date scientific studies or treatments, but to be comfortable and capable of communicating truthfully and empathetically to our patients about the realities of life- that we will all age and we will all die. The true challenge is combining all our medical knowledge and skills with the art of communication, to allow our patients to choose how they want to live—all the way to the end.
Being Mortal, the Frontline documentary from writer/producer/director Tom Jennings, airs Tuesday, February 10 on PBS and will stream in full online at pbs.org/frontlinehttp://pbs.org/frontline.