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tv   After Words  CSPAN  January 1, 2015 8:56pm-9:22pm EST

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fight so much advertising in the media and has so much i believe influence to the story. there's a story in a the book about a sales department calling a producer and commenting on stories that he was having me do about a cholesterol lowering -- lowering statin drug and that could harm business. because of that we haven't covered a lot of pharmaceutical issues that we should be covering in those can be important. >> host: any advice for young journalists getting into this business. it's changing all around the state by day. any advice for young folks? >> guest: it's tough. you don't do what the bosses want when they want you to do something that you think is not quite right we get the next job? is hard to say but i think there's room for people to follow a story and where it's going. don't lead but follow it. try to resist the temptation to let others take into place where you could tell they would like it to go and make your argument
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that this is where the story really does. i think there's a lot of outlets outlets. i don't think we are going back to the world peace to have for most people got their news from three stations in the newspapers but i do think something new will be born of it. it's got to work itself out so people can separate what is real from what is not. there's plenty of great reporting still be found in places like frontline and hbo vice and propublica project censored and the center public integrity. i think people find new ways to find the truth about the agencies they care about. it's just not going to be the same way they did before. >> host: what is next for you? >> guest: i'm just going to keep plugging along in the short term. i have published a lot of what i call orphaned stories. a story on premature babies in which these women say they have no idea they were even in the
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study and the government ethics body found the consent pole is unethical. some of the babies in the study died and were blinded. >> host: what can we find your were? >> guest: sharyl i try to cross-reference everything on sharyl >> host: thank you so much for chatting today. i've learned a lot and i hope journalists read this in your dogged spirit in investigating and good luck to you. >> guest: thank you. >> that was "after words" booktv's signature program in which authors of the latest nonfiction books are interviewed by journalists, public policymakers and others familiar with their material. "after words" airs every weekend on booktv at 10:00 p.m. on
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saturday, 12 and 9:00 p.m. on sunday and 12:00 a.m. on monday. and you can also watch "after words" on line. go to and click on "after words" in the booktv series and topics list on the upper right side of the page. >> host: our guest great to see you again. congratulations on your book being mortal. the book cover, i love it. it's got a piece of grass on the
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cover and it's got so much potential and symbolism. i immediately thought of walt whitman in his book leaves of grass. he has this famous quote i bequeath myself to the dirt to grow from the grass i love. what does a leaf of grass mean to you and why did you decided to put it on the cover. ..
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investigating why even in my own practice we don't do a very successful job of dealing with mortality. we reached we reached by the end of the 1990s a place where 80 percent of people died and institutions often hooked up to machines no chance to say goodbye, the chance to preserve some quality of life and it was clear that this was not what people want to do and i was not being successful at it. i began interviewing patient
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family members, over 200 patients about their experience with aging and the end-of-life or just doing with serious illness. i interviewed scores of hospice workers, nursing home workers and i learned about what some of them do that is really successful and i began trying at. my father was diagnosed with a brain tumor with his brainstem and spinal cord and unexpectedly easy to use some of what i was learning. >> was that a tough time for you personally? >> yes, it was. having the chance to understand what people who are more effective effective, whether as family members or clinicians, what they do make it less tough. it it was interesting. the core thing that came out of the lust for me was that people have priorities
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besides just living longer. it is tough to articulate and recognize that. the most reliable method of learning what people's priorities are is to ask. i was not asking, and i was not asking my own dad. and so when his condition began to deteriorate, a tumor that a tumor that was going to make him quadriplegic options radiation, surgery, i started asking the questions that people talk about asking, what are your priorities? what are the trade-offs you're willing to make the mac hard questions to ask yet changed every step of this care along the way.
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>> he lived to be 110 years old and lived in a village in india. tell me what you learned about his life. >> he is fascinating. he is the kind of old age we think we want. he needed 24 hour care basically. that he did not have to check into a a nursing home like you would be here. he would sit at the head of the table advice about who they should marry respected and venerated and he really was able to live as good a life as possible. what made that possible and what it would lose that? that was the lesson that came out of that. >> as a society.
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>> that was what america had the 19th century, what china, china, korea, and india are leaving right now. the breakup of the extended family is occurring because that worked only by enslaving the young young women to provide the care and on top of it his sons imagine reaching your 80s still waiting to inherit your land? having your economic future still dependent upon your dad. the economic the economic progress occurs because you give your people freedom. they moved to the cities, often take different lines of work, leave the elders behind and we did not have a plan in the 19th century for what happens to people left behind. what we have decided medicine we will take care of it.
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>> turn it over to the healthcare field and they will fix and take care of and treat. it. >> my dad is having trouble with memory or falls in the home. we like fixing problems. but some problems you can't fix. you can make them go away. you can say, well, you can you can try xyz or go see another specialist. and that is the failure of our understanding. there are things to fight for besides just living longer. >> when we go through school it seems like medical school, nursing schools attracted people, the type of high school student that wants to be a nurse a nurse is a remarkable person, the
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sort of person that interviews for medical school is a a remarkable person, and they come out in this dilemma. is it confusion of preparedness a sense of this is out of my league? where things go wrong when you have such great people going into the profession and are faced with dealing with the problem they feel is out of there league. >> a few things happen. number one i had a geriatric office, clinic right next to my clinic. for years i walked by and did not no what happened in there. let me hangout hang out with you for a day. and he showed me what i did.
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the most life-threatening things for some of his patients over 80 was that they might fall and if they fell and broke there hip they had an average of six months to survive and her miserable. miserable. more important than getting a mammogram, the colonoscopy was presenting a fall, and he knew how to do that, to examine the feet for ways to look for the toenails and calluses can make someone unsteady and arrange for a podiatrist to fix those problems. he would sit back and let them struggle because it told them something about their abilities. he went further and recognized something and reduced the drugs. he was not having trouble with dizziness and dehydration. >> not really necessary. >> they were not addressing the priorities.
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having as good a life is possible for as long as possible. when you understand it that way and you are making different choices and trade-offs that did not matter but that you were alive to do the things you want to do. the biggest priority was keeping her home. if i ask you do you no the four risk factors for someone the likelihood of following in the three most important things that we can do we don't no that. and so we did not teach people along the way and residency, medical school before that, the science of the aging body and dying the skills required to help people achieve the best possible outcome. it often
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is actually something requiring the deployment of medical technology for different goals and i think that what has happened is our medical values are fundamentally about health and survival without realizing well-being the lowest paid people and our profession geriatricians, psychiatrists primary care physicians and it is because these professions take time to talk to people. but having the payment of our people to have the time to talk and make, get an understanding of what matters in people's lives and then make the plans accordingly just does not remotely pay as well as deciding we can do an operation, or we can do that colonoscopy. >> i i did not even no there was a field of medicine called geriatrics did you?
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>> no, i did not. >> i understand it. a crew it grew like pediatrics. specialized in infectious diseases or primary care but did it. and as i think about these issues you talk about i wonder what is happening to geriatrics today. >> it is in decline. at the time we have more elderly people than ever we have fewer people than we did a decade ago. the profession itself, so far behind the eight ball the country has been ignoring the fact that we don't train geriatricians, pay geriatricians that we have to give up on the idea that their will be enough for the need. we have to train the skills we have to make these basic skills of the checklists.
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the checklists that have to be executed on the most important ones for people who are facing aging and address the particular health risk. the stepping back in an higher than that, being able to ask the key questions and get some skills and improvement along the way in hell to ask people about the priorities in life effectively. just because you're talking about the worst-case scenario does not mean that you are saying i am giving up on you. >> medical school seems to be overly reducing it the equivalent of learning so many foreign languages that the only way you can learn things is to pair things diagnosis, treatment, diagnosis, treatment.
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a reflex, diagnosis, treatment. what is great is you can learn all of this knowledge, and there is plenty of it out there to learn but what is concerning is you can miss out on a sense of what is appropriate, appropriateness, and that seems to be one of the focuses, the issues around the end of life as you describe in the sense of when is it appropriate? why are we treating high cholesterol when someone has a life expectancy of less than two years. >> and the medication makes them dizzy and likely to fall. >> i think that brings up a core.which is how do we deal with the fear that people have, dealing with appropriateness means it is no longer about my choice about what is appropriate. i appropriate. i think we're seeing in evolution about what it means to be a dr.
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fifty years ago it was the paternalistic dr. knows best. the dr. would tell you what you are going to get, might or might not tell you what is really going on, never would go through the options. >> yes, dr., whatever you say kind of, whatever you say kind of thing. >> and also you don't want to worry people. we rebelled in the 70s, 80s and 90s about that and by the time you and i were trained we were taught to be doctor informative i call it. you go through all the options, talk about the pros and cons and risks and benefits and then go, what would you like to do? which one do you want? and invariably you find this. they say, well i don't know, what would you do dr. what do we get
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taught to say? it is not my decision. this is your decision. you have to be the one decision. you have to be the one to decide. what is evolving is the recognition of what i began to see, they play the role of counselor. the counselor says, while here are all the options, but i need to need to ask you a few questions to understand your life. people want options and guidance, and it has to come from your understanding of their priorities in life and you have to be good at listening in a short conversation, and they are really good at it. they will ask, what is your understanding of your health your fears and worries for the future, the goals that you have if you health worsens? what are the outcomes that would be unacceptable to you back and based upon that well option a, well, that doesn't work. option b doesn't work. option c may be the way option c may be the way to work. you know what, none of them worked. we may have to come up with another solution.
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an example, a patient said my priority is a wedding i want to get to this saturday we focused on using medical technology to get her to that wedding. that that is what is cool to be a dr.. >> the first time you had to break bad news to a patient, do you you remember that? what was it like? >> i remember it mainly because as an intern you would be asked to go in and get the informed consent or as we termed it, go consent them. and you would invariably be explaining this operation talking about the risks and benefits. you have this risk of death, terrible bleeding, infection invariably they raise their eyebrows and say no one
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said anything about that. we all have our way of evading it. you watch the chief and what do they do? may end up saying, saying, these are just the forms. don't worry about it. you know, what do we do? how can we possibly even no what the complications are like? we read about them, but them, but how do we counsel people? when i met people who were good about walking through a conversation about whether you want i do not resuscitate order or not or consent discussion, they treat that conversation the same way people treated us how to do an operation. they broke it down, studied how -- what the component parts are and they recognize there are certain questions more effective than others.
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you need to use questions. one explained to me, you need to track yourself. you should be talking less than 50% of the time you are in the room with the patient. i tracked myself, and i was talking 90 percent of the time. and, you know, that set of skill, how do you break the news to someone? there are good ways and bad ways. the bad way is give all the fact that none of the meeting. >> retreat to medical vocabulary. >> exactly. the data, chances of this, chances of that. the effect of conversation is here is what i know, and i am worried. i am worried about these kinds of complications in you. i am not worried about these other ones. i am very hopeful about certain things.
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i wish that -- you know, they talk about, about, i worry, i hope, i wish. i wish it were true that we could cure this. i i hope that we we will be able to buy you more time. i am worried you may end up back in the hospital again. that is saying to people here is the data, here is your understanding and i am on your side on this. and i admit, i have some uncertainty about this. i am not positive. i tell i tell the story of these in my dad i thought towards the very end that this was it the moment he was gone, and he woke up. three more days. >> you know, as you say some of those phrases, it reminds me of the importance of the part of language as a
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doctor. i remember and med school mentors told me, don't ask patients are you taking your medications because you we will get the sense -- a lot of people have a tough time taking medication as they should. how have you been doing with it. there is amazing disconnect or alienation with one set of vocabulary. when you phrased things a certain way talk talk about end-of-life issues, it almost invites a conversation. >> there are two things i think i think we are missing. words matter, and the stories matter and part of even writing a book like this and doing the kind of investigation i did was deliberately a journalistic investigation. i was less interested in taking out the details and nuances and complexities and make it so when you do a randomized trial you remove all the detail and look at only what everyone has in common. what we do and a careful
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case study is recognize that the stories are really powerful and tell you a lot about experiences of the body, experiences of elvis and in this case the experience of mortality. mortality. and i think we are increasingly willingness to recognize that those are just as important contributions to knowledge and our skilled professionals. >> i think of a time i was in a trauma bay and a patient died. a mother is happy and looked at me. mad at myself for not thinking through this ahead of time. what should i tell her?


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