AQP Book Club Being Mortal: Medicine and What Matters in the End, by Atul Gawande

Author :
Jessica Horn & Emily Bak

We are so excited to make our first contribution to Aequitas’ quarterly newsletter! As the newest additions to the team, we’ve spent some time over the course of our first year here trying to further educate ourselves on our industry to add value to our clients and candidates alike. Both avid readers, we decided to choose a healthcare related book to book-club internally. We settled on Being Mortal by Atul Gawande. For those of you who are unfamiliar with the book, first of all, READ IT! It’s excellent.

Atul Gawande is a general surgeon, and the CEO of Haven, and does a deep dive into the evolution of our country’s approach to treatment and care for the elderly and dying population. As science and medicine have advanced, people are living longer, but more often than not, suffering more. Treatment has become very institutionalized and he illustrates what care looks like today through personal stories and those of his own patients and peers. Needless to say, this sparked a lot of interesting dialogue between us and our team. We talked a lot about our own healthcare journeys and realized how fortunate we are to be exposed to so much innovation in our work. We feel grateful to work with companies that are striving to create opportunities for the future of healthcare and we want to open up the conversation to all of you.

Emily: As an intern, I always thought that what we did was really interesting, but now working here full time, I realize how applicable and valuable what we do is to the real world. While in college, whenever I got sick or had to go to the doctor, I would hand them my parents’ insurance card and never see a medical bill, getting the care I needed and thinking that this magical little card made going to the doctor easy and free. Post-graduating college, I’m realizing how challenging navigating the healthcare world can be. I no longer have the flexibility I did in college, a relationship with a doctor I trust, or the convenience and time to wait an entire month to see a doctor. One of my first weeks after moving to the city, I felt sick and went to the Urgent Care near my apartment. After waiting for a couple hours, getting to see the doctor for only ten minutes, and then getting prescribed medication, it led to me receiving a $1,000 bill in the mail, with charges for things like “going at night,” something that seemed ridiculous to me as the only time I could have gone was after work. When I came into work the next day upset, one of our coworkers reminded me that I should have used Slingshot Health. The platform allows individuals to see doctors in a low cost, convenient way. This creates the balance of getting treatment even with time constraints, something that would have been great in that situation, and pretty much any time, as I adjust to professional life. He told me that he’s met doctors that he now sees regularly and interacts with directly rather than going through admin to book appointments. I’m excited about this option of building more trustworthy relationships with my doctors, having the reassurance that if I do ever get sick, the process of getting better won’t be a burden.

Jess: I totally remember how overwhelmed I felt when I first graduated from school and experienced similar pressure when it came to prioritizing my budget, health, and time, no longer having the luxury of free time like I did in college. I think I’ve finally started to figure it out. As I’ve moved through different phases in life and career opportunities, it has become more and more important to me to find a balance, especially living in New York City. While New York is charged with energy and much fun to be had – it’s also crazy and overwhelming. A few years back I completely hit a wall, finding myself pulled in many different directions, and an opportunity to move to Denver presented itself. I love to ski, spend time in the mountains, and felt that living in another city could give me some perspective. After living there for a couple of years, I walked away with a greater sense of self and a better understanding of what I need to incorporate in my life to make me feel healthy. Now that I am back in New York, I’ve carried these lessons with me, and make it a priority to create time for myself, allowing me to be efficient at work, manage my time, and be the best version of myself for the people I love. I try to say “no” to things that don’t serve me, spend time with the people who share the same values, and create opportunities to leave the craziness of the city and spend time outside. I’ve learned that the times when I have low energy or stress, it’s often because I’m burnt out and not fully supporting my well-being and mental state.

Emily: There were a lot of examples in Being Mortal that demonstrated exactly what you’re talking about. When people are treated in a way that serves them as individuals, they find purpose and meaning in their lives, ultimately changing their overall wellbeing. In one example, animals, plants, and even a children’s daycare were placed into a nursing home. Just these few additions did more for the residents than the antidepressant drugs they were given prior. According to the book, compared to an average nursing home, the total cost of drugs fell by 38%, and deaths fell by 15% of the control facility. By bringing personalized care and attention to these people, and surrounding them with things that brought them joy, the overall desire to be alive and present increased. Whether it’s spending time outside in the mountains of Denver or caring for a bird within a nursing home, it’s important to consider that healthcare isn’t solely about the physical body, and that finding that greater sense of self increases overall happiness. As exciting as the city can be, it can feel lonely if you’re not taking the time to stabilize your mental health and do the things that make you feel connected to others. Purpose, meaning, and connection can be more valuable to quality of life than taking a pill.

Jess: I love that part of the book. It’s such a simple concept – to encourage individuality – that it’s hard to believe how revolutionary it is. I guess it is easy for us to take this for granted because we are exposed to people and organizations that are trying to instill this mindset every day. In our universe, we’re constantly speaking to execs or working with companies that are working towards elevating the human experience when it comes to taking control of our own health and having transparency. Even the most general form of care is being revolutionized. We see it with companies like Eden Health, for example, that is building a Primary Care platform to help people seamlessly navigate through their healthcare journeys. Not only do they make it easy to book appointments and make insurance costs more transparent and less stressful for patients to understand, but each person is assigned to a designated care team that will learn about his or her individual health and is available to them at any time. I imagine it’s such a relief to talk to a clinician that actually knows you and your story. I feel like I’m constantly having to explain my medical history over and over again or having to gather my past records. I never know whether I’m painting an accurate picture. This emphasis on building a relationship and having an option to speak to my own team through an app on my phone or even see them in person if I need to is so valuable.

Overall, you’re right, Em. There is a clear shift in mindset industry-wide in care delivery. Companies like Eden are emphasizing the benefits of primary care to prevent problems before they begin. Another one of our clients, T1D Exchange, is building a platform to help individuals living with Type I diabetes better manage their disease by leveraging real world data to improve outcomes for this population, along with educating the people that are caring for them. After reading Being Mortal, we’ve learned that there’s even a shift in what treatment looks like for terminally ill patients.

Atul Gawande talks about how very sick patients are gravitating towards living out their days in their own home and choosing hospice versus opting for treatment (whether it’s chemo, radiation, a new drug trial, or surgical procedures) where there is no guarantee that it will extend their lives and more often than not the treatment will decrease the quality of life.

There’s a study conducted in the book where researchers compare patients with stage IV lung cancer receiving two different approaches to treatment. One group received the usual oncology care (chemo), the other half received the usual care plus visits with a palliative care specialist. The group who saw a specialist stopped chemotherapy treatment sooner, entered hospice earlier, suffered less, and lived longer (by up to 25%). I think that this increase in awareness and move towards allowing people to make decisions about their own health, helps them figure out what is most important to them, no matter how scary. I’m witnessing this firsthand as I see how my parents and their siblings are approaching care for their parents who are sick. As my grandmother’s health is declining in her old age, it’s hard not to hope that a new drug or treatment might prolong her life. I doubt that when she was younger and healthier she was asked how she’d like to live out the end of her life. Despite how uncomfortable this conversation probably is, I can’t help but think that I would like to learn from this and broach this topic with my own parents. I would rather hear what’s important to them. We should all be able to make these decisions for ourselves.

Emily: I completely agree, and also felt that I would want to have this sort of conversation with my parents sooner than later. I think painful situations could become more tolerable if we educate ourselves and talk about what matters while we still can. Atul Gawande shows us how educating patients has become extremely important, we see evidence of this in some of the solutions our clients are building. Doctors are putting more of an emphasis on offering options, not just delivering treatment. Providing a well-rounded education on the consequences and options in treatment is necessary for the patient to make informed decisions. In Being Mortal we see many examples of how patients have better outcomes when their doctors spend time giving options rather than giving orders. When working with a client like CarePort Health, it isn’t difficult to convince people of their mission, as most people have come into contact with a situation where they, or someone close to them, feel lost and uninformed within the healthcare system. CarePort collects data to allow patients to make more educated decisions about post-acute care facilities. The product suite helps patients to understand that they can make choices and have more control over their own care rather than being handed a list of rehab centers at discharge and expected to choose at random. With a patient’s ability to see all of the options and information laid out, they have a say in their care journey that will lead them to making decisions that align most with what they hold valuable in their lives. It’s important to recognize that more people want to have a voice in their care, which is why so many companies like CarePort are creating innovative products to change the traditional system.

After reading this book, and coming into contact with different innovative companies everyday, we see healthcare moving towards people customizing their own healthcare experiences around what matters most to them, which in turn is affecting the doctor-patient relationship. Doctors have to take into account the whole person, and recognize that there isn’t one right way to treat or care for someone. For example, I want the convenience and low cost way of seeing a doctor, knowing that when I get sick, I can easily see someone I trust to give me the care I need. What’s important to Jess is a doctor who sees the whole person, encompassing everything from physical to mental health. People want a say and options in their care journey, a major theme in the book as well as in the companies we work with everyday. When you have a say in your healthcare experience and are being listened to and cared for in more of a holistic sense, your health and wellness can drastically improve, experienced through two New Yorkers and through the stories told in the book.

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