Dennis McCullough wants elderly patients, their families and the medical professionals who care for them to stop, listen and thoughtfully plan for the one outcome every patient will have: death.
A physician and author of "My Mother, Your Mother: Embracing `Slow Medicine,' the Compassionate Approach to Caring for Your Aging Loved Ones" (HarperCollins), McCullough believes that the cascade of medical interventions that usually follow rushing some elderly patients to the emergency room can cause more suffering than good. A geriatrician at Dartmouth College, McCullough espouses establishing a relationship in which doctors, nurse practitioners, patients and families talk in a non-hurried way about their end-of-life preferences.
Taking time to listen, share perspectives
"It expands the concept of an advanced directive," explains Robert Kane, M.D., who directs the Center on Aging and the Minnesota Geriatric Education Center at the University of Minnesota. "This involves a much more gradual conversation that goes on over time, that is slow enough to be able to involve the family and to surface differences of opinion."
The bias in this approach is to do less rather than more, according to Kane. That has led some to criticize it as being unfeeling and doctor-centric. Stanley Smith, M.D., a geriatrician with Stillwater Medical Group, disagrees.
"It is sad that some people think that I am trying to write old people off when I am trying to follow the person's wishes for end-of-life care," Smith says. "I'm trying to be compassionate and contemplative about their care."
Not one-size-fits-all
To better provide appropriate and humane care for residents near the end of life, Smith explains, "No simple algorithm can choose the optimal medical therapy for this population. What is required is an individualized risk-benefit analysis that attempts to honor the patient's and caregiver's unique situation for each intervention. This requires a healthcare provider with extensive knowledge and time to discuss these issues."
