The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life

The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life

A palliative care doctor on the front lines of hospital care illuminates one of the most important and controversial ethical issues of our time on his quest to transform care through the end of life. It is harder to die in this country than ever before. Statistics show that the vast majority of Americans would prefer to die at home, yet many of us spend our last days f...

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Title:The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life
Author:Ira Byock
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Edition Language:English

The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life Reviews

  • Laurie

    Dr. Byock is the head of the department of palliative care at Dartmouth-Hitchcock Medical Center and a professor at the associated medical school. This means he has dealt with a lot of patients who are reaching the end of their lives; his job is to make that end as comfortable and stress free as possible for both them and their families. It is his contention that Americans today suffer more and die worse deaths- and more expensive deaths- than ever before. How is this possible in an age when the

    Dr. Byock is the head of the department of palliative care at Dartmouth-Hitchcock Medical Center and a professor at the associated medical school. This means he has dealt with a lot of patients who are reaching the end of their lives; his job is to make that end as comfortable and stress free as possible for both them and their families. It is his contention that Americans today suffer more and die worse deaths- and more expensive deaths- than ever before. How is this possible in an age when there are so many medical treatments available?

    Part of it is that the patients don’t make their wishes known via advance directives. If a person comes into a hospital without one, and they are unable to make their wishes known, the hospital has the right and obligation to do everything they can to prolong life. While this is absolutely the right thing to do most of the time, it isn’t always what the person really wants. When a person is near death from cancer, say, and takes a fall that creates a brain bleed, the hospital will put them on life support and prolong their life, even if there is no chance of recovery. Would that person have wanted that, or would they prefer to let go at that point? Who wants to live another 2 weeks if they are intubated, on a ventilator and semi-conscious at best? But doctors have an obligation to preserve life, and the family feels guilty if they say ‘pull the plug’.

    Add to this problem the fact that doctors get almost no training in palliative care and end of life issues. Many don’t know the best ways to deal with pain and fear, or even how to broach the subject of impending death. Some even hesitate to prescribe opiates because they are addictive- as if that could possibly be an issue for a dying person. These things need to be addressed in medical school. Medicare adds to the problem by not paying for palliative care or hospice care if the patient is still being treated for their health problem; I know from experience that some of these treatments should NOT be considered as trying to cure the patient but rather offering a better quality to their remaining life.

    This book achieved what I would have thought impossible: it’s both very difficult to read, because the subject matter is emotional and painful for someone who has dealt with end of life issues, but easy to read because of Dr. Byock’s talent with words. He includes medical details but at a level that is understandable to all; he includes details about death that don’t gross a sensitive person out. I hope that this book gets very widely read by both doctors and lay people; having gone through five deaths in our families it would have been much easier on us as family and on the patients if we’d known a lot of what is in this book way ahead of time- and if the doctors had been more comfortable dealing with end of life.

  • Meghan Poperowitz

    I may be biased because I have had the opportunity to work with Dr. Byock and his team at Dartmouth- he and his team are some very special people. I may also be biased because I focus on and promote Palliative care in my practice as a staff nurse. However, this is an excellent read for both practitioners and lay people on prioritizing PEOPLE in healthcare not diagnosis a by providing the best care possible - especially leading to and during the last phase of one's life. I recommend ALL his books

    I may be biased because I have had the opportunity to work with Dr. Byock and his team at Dartmouth- he and his team are some very special people. I may also be biased because I focus on and promote Palliative care in my practice as a staff nurse. However, this is an excellent read for both practitioners and lay people on prioritizing PEOPLE in healthcare not diagnosis a by providing the best care possible - especially leading to and during the last phase of one's life. I recommend ALL his books to everyone.oo

  • Steven Chang

    A MUST read for any future physicians, pre-health students, or anyone that is interested in a career that deals with patients. Byock understands exactly what this generation has become and what it needs to be regarding care for terminal patients. He shares many stories and examples of what it truly means to care for a patient. Countless times, we hear physicians say, "I'm sorry, there is nothing more we can do to help your illness." Byock argues that should NOT be the case for any physician beca

    A MUST read for any future physicians, pre-health students, or anyone that is interested in a career that deals with patients. Byock understands exactly what this generation has become and what it needs to be regarding care for terminal patients. He shares many stories and examples of what it truly means to care for a patient. Countless times, we hear physicians say, "I'm sorry, there is nothing more we can do to help your illness." Byock argues that should NOT be the case for any physician because there is always a way to help patients. He understands that these patients are human beings with emotions, not test subjects, experiments, or organic vessels. In a generation where healthcare is continually growing, he informs current and future physicians to see patients as PEOPLE and to care for them with utmost love. I mean... wouldn't we all want to be comforted in that way? Even if there are no more treatments to "prolong life," Byock understands that 1 month of happiness, love, and care is better than 1 year of pain, testing, and continual treatment. I highly recommend this book!

  • Sallie

    This is a perfect companion piece to "Being Mortal," which I recently reviewed. Byork has ideas that should spark reform in this book with a positive and loving message. Everyone should be able to expect humane care and comfort as they reach the end of their lives--and not be subjected to treatment without a substantial possibility of improving the quality of days--not just their quantity.

    In Byork's opinion, we'll need almost a revolution to bring Americans to the place where they can accept de

    This is a perfect companion piece to "Being Mortal," which I recently reviewed. Byork has ideas that should spark reform in this book with a positive and loving message. Everyone should be able to expect humane care and comfort as they reach the end of their lives--and not be subjected to treatment without a substantial possibility of improving the quality of days--not just their quantity.

    In Byork's opinion, we'll need almost a revolution to bring Americans to the place where they can accept death as part of life, and only then will we be able to engage aging people in planning for their own meaningful final months of life. Byork's medical specialty is palliative care, which does not equate simply to 'hospice,' regardless of what most of us believe. To him, palliative care means helping people be comfortable and to experience unconditional love. I have been notoriously hard on old people (yes, I am one)--impatient and annoyed oftentimes, by the slippage that occurs as we dwindle into our frail years. I am rethinking my bias against old age as a result of reading this compassionate work.

  • Lisa Shultz

    Ira Byock, MD has written another gem of a book. If you don't understand the power of palliative care to foster quality life, comfort at the end of life, and the prospect of gentle death, this book will illuminate you. Filled with patient stories that show how addressing death and working together to achieve a peaceful end of life is possible and can create healing and closure.

    The end of the book is a strong call to transform the way we die in America. The author feels that "How we die is alrea

    Ira Byock, MD has written another gem of a book. If you don't understand the power of palliative care to foster quality life, comfort at the end of life, and the prospect of gentle death, this book will illuminate you. Filled with patient stories that show how addressing death and working together to achieve a peaceful end of life is possible and can create healing and closure.

    The end of the book is a strong call to transform the way we die in America. The author feels that "How we die is already a public health crisis, and care of people through the end of life is poised to become a generation-long social catastrophe." He further states that "the way many Americans die remains a national disgrace."

    Dr. Byock writes with compassion and purpose. If you are willing to face the inevitable fact that you will one day die and that others might depend on you to make choices and decisions for them, this book is worth your time. It might even spark your desire to influence social change. Dr. Byock states that "For the magnitude of change that is needed to occur, social activism is necessary." Death unites us all.

    How do you want to die and do you deserve "The Best Care Possible"?

  • Kathleen Ambrose

    This is an excellent book! Palliative care and hospice care are differentiated and at the same time shown to be unified in their goal to provide the means for the best care possible in the end of life.

    Seven years after this book was published, there are many more discussions, more books published and more palliative-hospice programs being developed. I wonder how many were indirectly fruits of this work.

    I particularly liked hearing the stories of the different patients and Dr. Byock’s compassio

    This is an excellent book! Palliative care and hospice care are differentiated and at the same time shown to be unified in their goal to provide the means for the best care possible in the end of life.

    Seven years after this book was published, there are many more discussions, more books published and more palliative-hospice programs being developed. I wonder how many were indirectly fruits of this work.

    I particularly liked hearing the stories of the different patients and Dr. Byock’s compassionate work with each.

  • Ann

    Y'all. Please read this. Talk to your loved ones about their frickin wishes for end of life. Use the resources available to have the best care possible and enable your loved ones to die well.

  • Kathryn

    Written by one of the leaders in the Palliative Care field, this writer is a good story-teller, and tells the reader interesting and illustrative stories about some of his dying patients. Probably the most salient and astonishing point he makes in the book, is that patients, facing a life-threatening illness, who tell their doctors to do "whatever it takes, at all costs", in order to prolong their life, statistically, don't live as long as patients who tell their doctors to make them as comforta

    Written by one of the leaders in the Palliative Care field, this writer is a good story-teller, and tells the reader interesting and illustrative stories about some of his dying patients. Probably the most salient and astonishing point he makes in the book, is that patients, facing a life-threatening illness, who tell their doctors to do "whatever it takes, at all costs", in order to prolong their life, statistically, don't live as long as patients who tell their doctors to make them as comfortable as possible, preferring quality over quantity. In other words, if you choose quality, you get quantity - a longer life - as a bonus. He makes the reader think about our end-of-life choices and preferences, and those of our loved ones, which everyone should do.

  • Lola

    I didn't read the entire book--just skipped here & there; what I did read was interesting.

    Our country is messed up when it comes to medical care.

    Don't ever think that your advance directive will be followed--or even looked at.

    Always have a family member present when your care is not acceptable; have them stay with you

    until the care is acceptable--whether in the hospital or a nursing home.

    If your doctor leaves the exam room before answering all your questio

    I didn't read the entire book--just skipped here & there; what I did read was interesting.

    Our country is messed up when it comes to medical care.

    Don't ever think that your advance directive will be followed--or even looked at.

    Always have a family member present when your care is not acceptable; have them stay with you

    until the care is acceptable--whether in the hospital or a nursing home.

    If your doctor leaves the exam room before answering all your questions, stay put.

    They will need the room so someone will be along to get it ready for the next patient.

    Be courteous, be persistent until all your questions are answered.

    Look up doctors & health care facilities on "HealthGrades.com"

  • David Quinn

    There might be lots of very useful information in this book. The only problem is you need to read the friggin' thing to get to it and I couldn't even get to page 50 before I threw in the towel. Dr. Byock walks a very fine line between explaining how he goes about his business and being a shameless humblebrag.

    I wanted to give him the benefit of the doubt because I genuinely respect his line of work and am interested in the subject matter but the I, I, I, me, me, me started causing me to daydream

    There might be lots of very useful information in this book. The only problem is you need to read the friggin' thing to get to it and I couldn't even get to page 50 before I threw in the towel. Dr. Byock walks a very fine line between explaining how he goes about his business and being a shameless humblebrag.

    I wanted to give him the benefit of the doubt because I genuinely respect his line of work and am interested in the subject matter but the I, I, I, me, me, me started causing me to daydream and lose interest. (I imagined 12 people playing a drinking game where one person had to do a shot every time the phrase "the best care possible" appeared and calculated they'd all be dead from alcohol poisoning by page 8.)

    Even when he's describing the illnesses and care of particular patients he meanders about telling the reader how he does this, that and the other thing and how he's such an astute listener. Well he's a dreadful storyteller. Holy shit, what's easier than telling a succinct and interesting story about a medical patient? You can even pick any patient you'd like. It seemed ironic to me that a book about palliative care could be so painful.

    1 star for Byock's writing style and an overall 2 star rating because it may actually be a good book.

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