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There is an unspoken dark side of American medicine--keeping patients alive at any price. Two thirds of Americans die in healthcare institutions tethered to machines and tubes at bankrupting costs, even though research shows that most prefer to die at home in comfort, surrounded by loved ones.
Dr. Angelo E. Volandes believes that a life well lived deserves a good ending. Through the stories of seven patients and seven very different end-of-life experiences, he demonstrates that what people with a serious illness, who are approaching the end of their lives, need most is not new technologies but one simple thing: The Conversation. He argues for a radical re-envisioning of the patient-doctor relationship and offers ways for patients and their families to talk about this difficult issue to ensure that patients will be at the center and in charge of their medical care.
It might be the most important conversation you ever have.
- Sales Rank: #249869 in Books
- Published on: 2015-01-13
- Released on: 2015-01-13
- Original language: English
- Number of items: 1
- Dimensions: 8.55" h x .91" w x 5.75" l, 1.00 pounds
- Binding: Hardcover
- 240 pages
Review
"Volandes has . . . unswerving faith in a potentially world-changing idea." --Jonathan Rauch, "The Atlantic""" "A timely book, written with sensitivity, on a subject which pertains to every single human being and family in the world today." --Richard Selzer, MD, author of "Mortal Lessons""" "For too long, a conspiracy of silence has stood between Americans and the quality care they need, want, and deserve. "The Conversation "could change all that. Good quality care requires that the treatments are consistent with the values, preferences, and priorities of the people we serve. Now, through the stories in "The Conversation," Dr. Volandes shows how skillful communication can make the best of even the hardest situations." --Ira Byock, MD, professor, Dartmouth's Geisel School of Medicine; Chief Medical Officer, The Institute for Human Caring; author of "The Best Care Possible and Dying Well""" "My encounter with Dr. Angelo Volandes changed the way I think about life's most precious weeks and hours, and gave me hope for a better future. Your encounter with this passionate humanitarian and the heartbreaking, inspiring stories he tells will affect you the same way." --Jonathan Rauch, Senior Fellow, The Brookings Institution "Through seven stories of seven patients, Angelo Volandes movingly and evocatively tells the tale of how American healthcare does death wrong, often with tragic consequences, and how we can do it right. This is a book about how to live life as well as possible right up until the end, and it should be required reading for anyone who is mortal." --Shannon Brownlee, author of "Overtreated""" "Part memoir, part tales from the trenches, part guide, "The Conversation" shows how medicine fails patients with serious illness, then offers a different, better approach to improve not only how we die but--more importantly--how we live." --Louise Aronson, MD, Director, Northern California Geriatrics Education Center and UCSF Medical Humanities "Volandes has done more than anyone to translate the incomprehensible and the unimaginable into clear visual terms for real human beings trying to decide how they want to be cared for in the future." --Diane Meier, MD, Director of the Center to Advance Palliative Care; Professor of Geriatrics & Palliative Medicine, Mount Sinai School of Medicine
"A timely book, written with sensitivity, on a subject which pertains to every single human being and family in the world today." --Richard Selzer, MD, author of "Mortal Lessons""" "For too long, a conspiracy of silence has stood between Americans and the quality care they need, want, and deserve. "The Conversation "could change all that. Good quality care requires that the treatments are consistent with the values, preferences, and priorities of the people we serve. Now, through the stories in "The Conversation," Dr. Volandes shows how skillful communication can make the best of even the hardest situations." --Ira Byock, MD, professor, Dartmouth's Geisel School of Medicine; Chief Medical Officer, The Institute for Human Caring; author of "The Best Care Possible and Dying Well""" "My encounter with Dr. Angelo Volandes changed the way I think about life's most precious weeks and hours, and gave me hope for a better future. Your encounter with this passionate humanitarian and the heartbreaking, inspiring stories he tells will affect you the same way." --Jonathan Rauch, Senior Fellow, The Brookings Institution "Through seven stories of seven patients, Angelo Volandes movingly and evocatively tells the tale of how American healthcare does death wrong, often with tragic consequences, and how we can do it right. This is a book about how to live life as well as possible right up until the end, and it should be required reading for anyone who is mortal." --Shannon Brownlee, author of "Overtreated""" "Part memoir, part tales from the trenches, part guide, "The Conversation" shows how medicine fails patients with serious illness, then offers a different, better approach to improve not only how we die but--more importantly--how we live." --Louise Aronson, MD, Director, Northern California Geriatrics Education Center and UCSF Medical Humanities "Volandes has done more than anyone to translate the incomprehensible and the unimaginable into clear visual terms for real human beings trying to decide how they want to be cared for in the future." --Diane Meier, MD, Director of the Center to Advance Palliative Care; Professor of Geriatrics & Palliative Medicine, Mount Sinai School of Medicine "Worth the price of the book alone is Volandes' easy-to-follow guide for determining and making known one's end-of-life wishes." --"Booklist""" "Written with passion and clarity, this book moves beyond others on the topic by including empirical evidence of how to make such conversations about end-of-life care most effective." --"Library Journal" "Appropriately, Volandes neither attempts nor claims to be impersonal or unemotional about this charged topic; rather, he brings his personal and professional experiences as well as research to his impassioned argument . . . [He]makes his points succinctly and convincingly and offers readers the tools to make change within their own lives." --"Shelf Awareness" "A thoughtful and thought provoking book that confronts the fear of death with the grace of wisdom and understanding." --"Spiritualty and Health"
Enlightening.--Jane Brody "The New York Times "
A timely book, written with sensitivity, on a subject which pertains to every single human being and family in the world today.--Richard Selzer, MD, author of MORTAL LESSONS
For too long, a conspiracy of silence has stood between Americans and the quality care they need, want, and deserve. "The Conversation "could change all that. Good quality care requires that the treatments are consistent with the values, preferences, and priorities of the people we serve. Now, through the stories in "The Conversation," Dr. Volandes shows how skillful communication can make the best of even the hardest situations.--Ira Byock, MD, professor, Dartmouth's Geisel School of Medicine; Chief Medical Officer, The Institute for Human Caring; author of THE BEST CARE POSSIBLE and DYING WELL
My encounter with Dr. Angelo Volandes changed the way I think about life's most precious weeks and hours, and gave me hope for a better future. Your encounter with this passionate humanitarian and the heartbreaking, inspiring stories he tells will affect you the same way.--Jonathan Rauch, Senior Fellow, The Brookings Institution
Through seven stories of seven patients, Angelo Volandes movingly and evocatively tells the tale of how American healthcare does death wrong, often with tragic consequences, and how we can do it right. This is a book about how to live life as well as possible right up until the end, and it should be required reading for anyone who is mortal.--Shannon Brownlee, author of OVERTREATED
Part memoir, part tales from the trenches, part guide, "The Conversation" shows how medicine fails patients with serious illness, then offers a different, better approach to improve not only how we die but--more importantly--how we live.--Louise Aronson, MD, Director, Northern California Geriatrics Education Center and UCSF Medical Humanities
Volandes has done more than anyone to translate the incomprehensible and the unimaginable into clear visual terms for real human beings trying to decide how they want to be cared for in the future.--Diane Meier, MD, Director of the Center to Advance Palliative Care; Professor of Geriatrics & Palliative Medicine, Mount Sinai School of Medicine
A timely book, written with sensitivity, on a subject which pertains to every single human being and family in the world today. Richard Selzer, MD, author of MORTAL LESSONS
For too long, a conspiracy of silence has stood between Americans and the quality care they need, want, and deserve. "The Conversation "could change all that. Good quality care requires that the treatments are consistent with the values, preferences, and priorities of the people we serve. Now, through the stories in "The Conversation," Dr. Volandes shows how skillful communication can make the best of even the hardest situations. Ira Byock, MD, professor, Dartmouth's Geisel School of Medicine; Chief Medical Officer, The Institute for Human Caring; author of THE BEST CARE POSSIBLE and DYING WELL
My encounter with Dr. Angelo Volandes changed the way I think about life's most precious weeks and hours, and gave me hope for a better future. Your encounter with this passionate humanitarian and the heartbreaking, inspiring stories he tells will affect you the same way. Jonathan Rauch, Senior Fellow, The Brookings Institution
Through seven stories of seven patients, Angelo Volandes movingly and evocatively tells the tale of how American healthcare does death wrong, often with tragic consequences, and how we can do it right. This is a book about how to live life as well as possible right up until the end, and it should be required reading for anyone who is mortal. Shannon Brownlee, author of OVERTREATED
Part memoir, part tales from the trenches, part guide, "The Conversation" shows how medicine fails patients with serious illness, then offers a different, better approach to improve not only how we die but--more importantly--how we live. Louise Aronson, MD, Director, Northern California Geriatrics Education Center and UCSF Medical Humanities
Volandes has done more than anyone to translate the incomprehensible and the unimaginable into clear visual terms for real human beings trying to decide how they want to be cared for in the future. Diane Meier, MD, Director of the Center to Advance Palliative Care; Professor of Geriatrics & Palliative Medicine, Mount Sinai School of Medicine
Worth the price of the book alone is Volandes' easy-to-follow guide for determining and making known one's end-of-life wishes. "Booklist"
Written with passion and clarity, this book moves beyond others on the topic by including empirical evidence of how to make such conversations about end-of-life care most effective. "Library Journal"
Appropriately, Volandes neither attempts nor claims to be impersonal or unemotional about this charged topic; rather, he brings his personal and professional experiences as well as research to his impassioned argument . . . [He]makes his points succinctly and convincingly and offers readers the tools to make change within their own lives. "Shelf Awareness"
A thoughtful and thought provoking book that confronts the fear of death with the grace of wisdom and understanding. "Spiritualty and Health"
Enlightening. Jane Brody, "The New York Times""
About the Author
Angelo E. Volandes is a physician and researcher at Harvard Medical School and Massachusetts General Hospital. He is also the co-founder of Advance Care Planning Decisions, a nonprofit organization devoted to encouraging The Conversation through the use of videos. He lives outside Boston, Massachusetts.
Most helpful customer reviews
26 of 26 people found the following review helpful.
Want to tranform healthcare? Read this book.
By Rae S Seitz, MD
Underway in this country is a monumental effort to transform healthcare, driven by the need to reduce waste, redundancy, and danger . What Dr. Volandes brings to the table is visibility into the lives of those who struggle to find their way through this complicated, confusing, and intimidating medical industrial complex and reveals the simple yet profound notion that we can take back control of what happens to us. What is astounding is that to take control we must start with the simple act of conversation. When we, as healthcare providers, caregivers, family members and loved ones can lovingly and courageously discuss what is most important to a person at the end of life, we can support and honor that person. We can ensure that he or she is treated in a manner consistent with what defines them; in short, we can change the world. This book puts us on that path.
17 of 17 people found the following review helpful.
Compelling, Required Reading
By William J. Kennedy
The Conversation serves as fascinating introduction to the life and work of Harvard Medical School physician researcher Angelo Volandes. As other reviewers have noted, the book is equal parts physician-patient narrative and how-to book in what it means to navigate life's final chapter. There are additional themes in the book of importance: the full circle of a father-son relationship, the complex interface between technology and human values, and how an aging population will touch us all in some way.
The writing is a superb combination of storytelling and practical advice. The stories- the professor and his wife, the poetry teacher, the young woman with breast cancer, the coal miner- conclude with Volandes' challenges in navigating The Conversation with his own father. You read about these lives spellbound and wanting more. Maybe it is because these characters are so real, we naturally start to think about what we would want in similar circumstances. Volandes walks with us on this journey with the final sections of the book offering real world advice for individuals and families. It is an incredible reading experience to start with these stories and end up at our own lives.
I heard Volandes interviewed on public radio recently and he distilled his message into what matters most: The Conversation is not about dying but living. It's about knowing what we want (and what our loved ones want) so we can live a better life in the face of whatever might happen in the future. At the heart of the book is an optimistic message, one that Volandes clearly believes in enough to dedicate his career to advancing. I cannot recommend The Conversation enough as a compelling novel and a start in clarifying some of the most important decisions we will ever make.
3 of 6 people found the following review helpful.
Not Revolutionary and Not for Everyone
By jiffy
"The Conversation," always capitalized, refers to a discussion with relatives and medical personnel regarding a person's wishes for care--or lack of it--at the end of life. This is hardly revolutionary--telling people what you want is about as basic as you can get. The hard part is getting guaranteed obedience. What if you don't have family members to have The Conversation with or if you can't trust the ones you have to put your wishes ahead of theirs? And if you don't believe in modern medicine and want to live and die outside the system, you're not going to have any doctor to talk to. I've shared my wishes with everybody in sight--my book club is tired of hearing them--but what are the odds that any of these people would be around when they were needed and who would listen to them if they were? I've had an advance directive for years which refuses all forms of medical treatment under any and all circumstances, and I have copies in my pocket, in my purse, on top of the television, on my bedroom door, and on the bathroom door. But the author says that's not enough. You need a person to speak for you, and there may not be one. You also need a DNR (Do Not Resuscitate order) to prevent being transported unconscious against your will. But the catch here is that only a medical professional can write a DNR, and most of them won't write one for an apparently healthy stranger. So what then? The author doesn't tell you.
Dr. Volandes is obviously an enlightened and compassionate person. But I was shocked when he said there are three options at the end of life--Life-Prolonging Care, Limited Medical Care, and Comfort Care. Think about that. Is the medical system so obsessed with its own importance that they can't even acknowledge an option that doesn't involve them? As I noted in my advance directive, "There has never in the history of the world been a single living organism that couldn't die by itself. The idea that the medical system has to be involved in every person's death is utter nonsense." Dying outside the system may not be everyone's choice and it certainly doesn't have to be. But it is an option for everyone to accept or reject, and Dr. Volandes never mentions it.
Far too much of the book is devoted to the use of videos to show people what Life-Prolonging Care actually entails. The author tells us that when patients and families see what it means to have CPR, intubation, ventilators, central lines, feeding tubes, etc., they make better informed choices and they are more likely to choose Comfort Care only. To me, that's pretty obvious, and I didn't need any proof. But the author goes on and on and on citing surveys and studies and extolling the merits of these videos, which he appears to be selling, although he never says that. Whether he is or not, even the possibility of hawking wares in a book of this nature is totally inappropriate.
This book deals with a very important subject and many people will find its message helpful or even vital. I'm happy for them. But for me the book totally missed the mark.
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