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Letting Go: how to plan for a good death by [Charlie Corke]

Letting Go: how to plan for a good death Kindle Edition

4.8 out of 5 stars 11 ratings

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Product description

Book Description

'Too frequently, we leave it too late to start to think - but a crisis is never the best time for careful thought.' --This text refers to the paperback edition.

About the Author

Dr Charlie Corke (MB BS., BSc., MRCP(UK), FCICM) is one of Australia's leading Intensive Care specialists and is currently President of the College of Intensive Care of Australia and New Zealand. He is the regional clinical lead for the Advance Care Planning program and is the originator of the MyValues approach to advance care planning ( Dr Corke lectures widely on medical communication and end-of-life decision-making, was featured on the ABC in the film In the End, and is a regular contributor to radio. --This text refers to the paperback edition.

Product details

  • ASIN ‏ : ‎ B0798255H9
  • Publisher ‏ : ‎ Scribe (29 January 2018)
  • Language ‏ : ‎ English
  • File size ‏ : ‎ 354 KB
  • Text-to-Speech ‏ : ‎ Enabled
  • Screen Reader ‏ : ‎ Supported
  • Enhanced typesetting ‏ : ‎ Enabled
  • X-Ray ‏ : ‎ Not Enabled
  • Word Wise ‏ : ‎ Enabled
  • Print length ‏ : ‎ 159 pages
  • Customer Reviews:
    4.8 out of 5 stars 11 ratings

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3.0 out of 5 stars viewpoint needs qualification
By Iain g Johnston on 3 September 2018
Book review
Letting go: How to plan for a good death
Dr Charlie Corke

This book is written by a highly regarded intensive care physician with decades of clinical experience. His book, Letting Go: How to plan for a good death is an examination of the issues and in particular short fallings of current medical care to provide a good death for patients who are seriously ill.
Dr Corke relates several cases of patients he has looked after interspersed with discussions analysing what could have been done better and ways in which he approaches the enormous challenges presented by end of life care.
The following aspects I found valuable:

1. Dr Corke’s book excels in emphasising how doctors need to take time and talk to patients in order to incorporate their values into decision making. He clearly has spent hundreds of hours getting to know his own patients and their families in a heartfelt manner, getting to know them not just as patients with disease, but as humans with interests, values and goals.
2. The influence of language and words on effective communication between doctors and family. How phrases like “we should try everything” need to be fleshed out in detail, meaning different things for families and medical teams.
3. Emphasising our necessity to discuss end of life issues beforehand; what treatments we would accept. This would include appointing a “tough” decision maker and penning an individualised letter clearly stating treatment limitations. Dr Corke describes the limited usefulness of generic advanced health care directives in addressing real life clinical scenarios and suggests a bold heartfelt letter carries more weight. He gives an example of such a letter with useful phraseology that certainly would influence family, medical teams and judiciary.
4. He cites a useful spectrum of studies surrounding beliefs and influences in end of life care, including some of his own studies. These highlighted the strong influence of word choice on family’s decision making and the reluctance of doctors to transition toward a non-interventional or palliative pathway.
However the following I found less valuable:
1. Dr Corke rightly describes the huge influence worldview has on patients choices, however Dr Corke does not describe his own worldview, which inevitably affects the way he selects and interprets the evidence, the patient stories among thousands he chooses as illustrative. In contrast, a recent book on the same subject “Dying Well” by Professor John Wyatt, neonatal paediatrician at University college London clearly states his worldview and allows us to interpret his thoughts with this in mind.
2. Observer bias. The difficulty of an intensive care specialist promoting a general paradigm is that the observed patients form a small minority of a hospital population, around 10%. These are by definition the sickest patients in the hospital. The other 90% generally are treated effectively and discharged home in more or less good health. Dr Corke levels some criticism towards medical specialists such as surgeons, oncologists and cardiologists because they appear to promote an ongoing interventionalist approach. However for these specialists, the norm, 90%, is for patients to do well- this group is however unseen by intensive care, and unseen by Dr Corke. Some pause should therefore be given in extrapolating evidence from the select 10% to apply to the 90%.
3. The same principle applies to time management. Most General practitioners and specialists have a limited resource of time to spend getting to know a patient and their families well, much as they might like to. Intensive care practice, with fewer patients offers the opportunity for this sort of relationship and detail to unfold. As intensive care specialists therefore we should not be surprised that no one has gone through detailed end of life discussions. Dr Corke is quite correct in saying this does not excuse specialists from not engaging in detailed and honest discussion when their patient does run into serious illness, although it must be recognised that these specialists, used to general success, have limited skills in conducting these discussions.
4. A false dichotomy. Dr Corke recounts extreme cases when things have been inordinately prolonged and invasive treatment lingered far beyond humane standards. He and we should be rightly upset in putting patients through these prolonged treatments with dwindling quality of life. The alternative he proposes is to prevent medical interventions from the outset. Of course the third alternative, commonly used in intensive care practice is to try an interventionalist approach at first, to see what response is achieved. This third approach was surprisingly not addressed in the book. I am not sure why.
5. Poor predictions. Advanced as medicine is, we are notoriously poor at predicting how any individual is going to fare at the point of admission. Patients who present at deaths door surprise us and survive. We are however much better at predicting survival and possible quality of life after a 1 to 3 days in hospital and therefore a better time to take stock.
6. Palliative care. In a book about a good death, Dr Corke gives more space to Dr Peter Singer and discussion of euthanasia than about the role of the specialty palliative care. Public perception and funding of Palliative care as a speciality is already terribly neglected versus in my view the media spectacle of the macabre euthanasia.
7. Medical accountability. Admittedly the current paradigm of “do everything” is not perfect, however it is somewhat failsafe and predictable for patients in that patients know where doctors stand- “treat, and in general interventionally and energetically”. If Dr Corke’s paradigm is dominant, this is not an absolute. In the wrong hands, this new paradigm could lead to laziness and nihilism, and in malignant hands, neglect. The default principle that doctor hold, the sanctity of life and protection of it, enforces medical accountability and enables the public to trust doctors.

Overall, Dr Corke’s view comes from years of looking after the terribly sick and provides some practical advice for patients and family to effectively communicate. It is also a wake up call for doctors to listen well. However this book forms only one viewpoint on how we should proceed in progressing our skills in this burgeoning area as populations age. Nothing could be more serious, it literally is a matter of life and death.
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Reviewed in Australia on 29 August 2018
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Reviewed in Australia on 18 December 2018
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