What we can do to die well | Timothy Ihrig | TEDxDesMoines
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0:07 - 0:09Thank you very much.
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0:10 - 0:12I am a palliative care physician
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0:12 - 0:15and I would like to talk to you
today about health care. -
0:15 - 0:19I'd like to talk to you
about the health and care -
0:20 - 0:23of the most vulnerable
population in our country -- -
0:23 - 0:28those people dealing with the most
complex serious health issues. -
0:29 - 0:32I'd like to talk to you
about economics as well. -
0:32 - 0:36And the intersection of these two
should scare the hell out of you -- -
0:37 - 0:38it scares the hell out of me.
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0:39 - 0:42I'd also like to talk to you
about palliative medicine: -
0:43 - 0:49a paradigm of care for this population,
grounded in what they value. -
0:50 - 0:53Patient-centric care based on their values
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0:53 - 0:56that helps this population
live better and longer. -
0:57 - 1:00It's a care model that tells the truth
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1:01 - 1:02and engages one-on-one
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1:02 - 1:04and meets people where they're at.
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1:06 - 1:10I'd like to start by telling the story
of my very first patient. -
1:10 - 1:12It was my first day as a physician,
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1:12 - 1:14with the long white coat ...
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1:15 - 1:16I stumbled into the hospital
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1:16 - 1:19and right away there's a gentleman,
Harold, 68 years old, -
1:19 - 1:20came to the emergency department.
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1:20 - 1:22He had had headaches for about six weeks
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1:22 - 1:25that got worse and worse
and worse and worse. -
1:25 - 1:29Evaluation revealed he had cancer
that had spread to his brain. -
1:30 - 1:35The attending physician directed me
to go share with Harold and his family -
1:37 - 1:40the diagnosis, the prognosis
and options of care. -
1:41 - 1:44Five hours into my new career,
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1:44 - 1:46I did the only thing I knew how.
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1:47 - 1:48I walked in,
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1:49 - 1:50sat down,
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1:51 - 1:52took Harold's hand,
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1:53 - 1:54took his wife's hand
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1:55 - 1:56and just breathed.
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1:58 - 2:00He said, "It's not good
news is it, sonny?" -
2:00 - 2:02I said, "No."
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2:02 - 2:05And so we talked
and we listened and we shared. -
2:06 - 2:07And after a while I said,
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2:07 - 2:10"Harold, what is it
that has meaning to you? -
2:10 - 2:12What is it that you hold sacred?"
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2:12 - 2:13And he said,
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2:13 - 2:15"My family."
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2:16 - 2:18I said, "What do you want to do?"
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2:18 - 2:21He slapped me on the knee
and said, "I want to go fishing." -
2:21 - 2:23I said, "That, I know how to do."
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2:24 - 2:26Harold went fishing the next day.
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2:27 - 2:28He died a week later.
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2:29 - 2:32As I've gone through
my training in my career, -
2:32 - 2:34I think back to Harold.
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2:34 - 2:36And I think that this is a conversation
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2:38 - 2:40that happens far too infrequently.
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2:41 - 2:45And it's a conversation
that had led us to crisis, -
2:45 - 2:48to the biggest threat
to the American way of life today, -
2:48 - 2:50which is health care expenditures.
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2:51 - 2:52So what do we know?
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2:52 - 2:55We know that
this population, the most ill, -
2:55 - 2:58takes up 15 percent
of the gross domestic product -- -
2:58 - 3:00nearly 2.3 trillion dollars.
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3:01 - 3:05So the sickest 15 percent
take up 15 percent of the GDP. -
3:05 - 3:08If we extrapolate this out
over the next two decades -
3:09 - 3:11with the growth of baby boomers,
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3:12 - 3:16at this rate it is 60 percent of the GDP.
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3:17 - 3:19Sixty percent of the gross
domestic product -
3:19 - 3:21of the United States of America --
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3:21 - 3:24it has very little to do
with health care at that point. -
3:24 - 3:26It has to do with a gallon of milk,
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3:27 - 3:28with college tuition.
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3:29 - 3:31It has to do with
every thing that we value -
3:31 - 3:34and every thing that we know presently.
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3:36 - 3:40It has at stake the free-market
economy and capitalism -
3:40 - 3:41of the United States of America.
-
3:44 - 3:47Let's forget all the statistics
for a minute, forget the numbers. -
3:47 - 3:51Let's talk about the value we get
for all these dollars we spend. -
3:52 - 3:54Well, the Dartmouth Atlas,
about six years ago, -
3:54 - 3:57looked at every dollar
spent by Medicare -- -
3:57 - 3:59generally this population.
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3:59 - 4:03We found that those patients who have
the highest per capita expenditures -
4:05 - 4:08had the highest suffering,
pain, depression. -
4:09 - 4:12And, more often than not, they die sooner.
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4:13 - 4:14How can this be?
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4:15 - 4:16We live in the United States,
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4:16 - 4:19it has the greatest health care
system on the planet. -
4:19 - 4:21We spend 10 times more on these patients
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4:21 - 4:23than the second-leading
country in the world. -
4:24 - 4:26That doesn't make sense.
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4:27 - 4:28But what we know is,
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4:28 - 4:31out of the top 50 countries on the planet
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4:31 - 4:35with organized health care systems,
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4:35 - 4:37we rank 37th.
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4:39 - 4:43Former Eastern Bloc countries
and sub-Saharan African countries -
4:43 - 4:47rank higher than us
as far as quality and value. -
4:49 - 4:52Something I experience
every day in my practice, -
4:52 - 4:56and I'm sure, something many of you
on your own journeys have experienced: -
4:57 - 5:00more is not more.
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5:01 - 5:03Those individuals who had more tests,
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5:03 - 5:04more bells, more whistles,
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5:05 - 5:07more chemotherapy,
more surgery, more whatever -- -
5:07 - 5:09the more that we do to someone,
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5:10 - 5:13it decreases the quality of their life.
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5:14 - 5:17And it shortens it, most often.
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5:19 - 5:21So what are we going to do about this?
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5:21 - 5:22What are we doing about this?
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5:22 - 5:24And why is this so?
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5:24 - 5:26The grim reality, ladies and gentlemen,
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5:26 - 5:29is that we, the health care industry --
long white-coat physicians -- -
5:29 - 5:31are stealing from you.
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5:32 - 5:34Stealing from you the opportunity
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5:35 - 5:37to choose how you want to live your lives
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5:37 - 5:40in the context of whatever disease it is.
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5:40 - 5:43We focus on disease
and pathology and surgery -
5:43 - 5:44and pharmacology.
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5:46 - 5:48We miss the human being.
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5:50 - 5:52How can we treat this
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5:52 - 5:54without understanding this?
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5:56 - 5:58We do things to this;
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6:00 - 6:03we need to do things for this.
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6:05 - 6:07The triple aim of healthcare:
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6:07 - 6:10one, improve patient experience.
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6:10 - 6:13Two, improve the population health.
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6:14 - 6:19Three, decrease per capita expenditure
across a continuum. -
6:21 - 6:22Our group, palliative care,
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6:22 - 6:26in 2012, working with
the sickest of the sick -- -
6:28 - 6:29cancer,
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6:29 - 6:31heart disease, lung disease,
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6:31 - 6:32renal disease,
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6:32 - 6:33dementia --
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6:35 - 6:37how did we improve patient experience?
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6:38 - 6:40"I want to be at home, Doc."
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6:40 - 6:42"OK, we'll bring the care to you."
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6:42 - 6:44Quality of life, enhanced.
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6:45 - 6:46Think about the human being.
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6:46 - 6:48Two: population health.
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6:48 - 6:51How did we look
at this population differently, -
6:51 - 6:54and engage with them
at a different level, a deeper level, -
6:54 - 6:57and connect to a broader sense
of the human condition than my own? -
6:58 - 7:01How do we manage this group,
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7:02 - 7:03so that of our outpatient population,
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7:03 - 7:0894 percent, in 2012,
never had to go to the hospital? -
7:09 - 7:11Not because they couldn't.
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7:12 - 7:14But they didn't have to.
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7:14 - 7:16We brought the care to them.
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7:16 - 7:20We maintained their value, their quality.
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7:22 - 7:25Number three: per capita expenditures.
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7:26 - 7:27For this population,
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7:27 - 7:32that today is 2.3 trillion dollars
and in 20 years is 60 percent of the GDP, -
7:32 - 7:37we reduced health care expenditures
by nearly 70 percent. -
7:38 - 7:41They got more of what they wanted
based on their values, -
7:41 - 7:43lived better and are living longer,
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7:44 - 7:46for two-thirds less money.
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7:52 - 7:54While Harold's time was limited,
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7:55 - 7:57palliative care's is not.
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7:57 - 8:02Palliative care is a paradigm
from diagnosis through the end of life. -
8:04 - 8:05The hours,
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8:05 - 8:08weeks, months, years,
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8:09 - 8:10across a continuum --
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8:10 - 8:12with treatment, without treatment.
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8:12 - 8:13Meet Christine.
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8:14 - 8:16Stage III cervical cancer,
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8:16 - 8:19so, metastatic cancer
that started in her cervix, -
8:19 - 8:21spread throughout her body.
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8:22 - 8:24She's in her 50s and she is living.
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8:26 - 8:27This is not about end of life,
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8:27 - 8:29this is about life.
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8:30 - 8:32This is not just about the elderly,
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8:32 - 8:34this is about people.
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8:35 - 8:36This is Richard.
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8:37 - 8:38End-stage lung disease.
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8:39 - 8:42"Richard, what is it
that you hold sacred?" -
8:43 - 8:46"My kids, my wife and my Harley."
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8:46 - 8:47(Laughter)
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8:47 - 8:48"Alright!
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8:50 - 8:53I can't drive you around on it
because I can barely pedal a bicycle, -
8:53 - 8:54but let's see what we can do."
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8:55 - 8:58Richard came to me,
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8:58 - 9:01and he was in rough shape.
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9:01 - 9:03He had this little voice telling him
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9:03 - 9:06that maybe his time was weeks to months.
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9:06 - 9:08And then we just talked.
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9:08 - 9:12And I listened and tried to hear --
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9:12 - 9:13big difference.
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9:13 - 9:15Use these in proportion to this.
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9:17 - 9:20I said, "Alright, let's take it
one day at a time," -
9:20 - 9:23like we do in every
other chapter of our life. -
9:24 - 9:28And we have met Richard
where Richard's at day-to-day. -
9:28 - 9:31And it's a phone call or two a week,
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9:32 - 9:36but he's thriving in the context
of end-stage lung disease. -
9:40 - 9:43Now, palliative medicine is not
just for the elderly, -
9:43 - 9:45it is not just for the middle-aged.
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9:47 - 9:48It is for everyone.
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9:48 - 9:50Meet my friend Jonathan.
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9:51 - 9:52We have the honor and pleasure
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9:52 - 9:55of Jonathan and his father
joining us here today. -
9:55 - 9:58Jonathan is in his 20s,
and I met him several years ago. -
9:58 - 10:01He was dealing with
metastatic testicular cancer, -
10:02 - 10:03spread to his brain.
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10:03 - 10:05He had a stroke,
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10:05 - 10:07he had brain surgery,
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10:07 - 10:09radiation, chemotherapy.
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10:11 - 10:12Upon meeting him and his family,
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10:12 - 10:15he was a couple of weeks away
from a bone marrow transplant, -
10:15 - 10:18and in listening and engaging,
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10:18 - 10:23they said, "Help us
understand -- what is cancer?" -
10:25 - 10:26How did we get this far
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10:28 - 10:30without understanding
what we're dealing with? -
10:30 - 10:33How did we get this far
without empowering somebody -
10:33 - 10:35to know what it is they're dealing with,
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10:35 - 10:38and then taking the next step and engaging
in who they are as human beings -
10:38 - 10:40to know if that is what we should do?
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10:40 - 10:43Lord knows we can do
any kind of thing to you. -
10:46 - 10:47But should we?
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10:51 - 10:53And don't take my word for it.
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10:53 - 10:57All the evidence that is related
to palliative care these days -
10:57 - 11:01demonstrates with absolute certainty
people live better and live longer. -
11:01 - 11:05There was a seminal article
out of the New England Journal of Medicine -
11:05 - 11:06in 2010.
-
11:07 - 11:09A study done at Harvard
by friends of mine, colleagues. -
11:09 - 11:11End-stage lung cancer:
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11:11 - 11:13one group with palliative care,
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11:14 - 11:15a similar group without.
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11:17 - 11:20The group with palliative care
reported less pain, -
11:21 - 11:22less depression.
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11:23 - 11:25They needed fewer hospitalizations.
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11:25 - 11:27And, ladies and gentlemen,
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11:28 - 11:31they lived three to six months longer.
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11:33 - 11:36If palliative care were a cancer drug,
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11:37 - 11:40every cancer doctor on the planet
would write a prescription for it. -
11:42 - 11:43Why don't they?
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11:45 - 11:48Again, because we goofy,
long white-coat physicians -
11:48 - 11:52are trained and of the mantra
of dealing with this, -
11:53 - 11:55not with this.
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12:00 - 12:03This is a space that we will
all come to at some point. -
12:05 - 12:07But this conversation today
is not about dying, -
12:07 - 12:09it is about living.
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12:09 - 12:11Living based on our values,
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12:11 - 12:12what we find sacred
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12:12 - 12:14and how we want to write
the chapters of our lives, -
12:15 - 12:16whether it's the last
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12:16 - 12:18or the last five.
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12:19 - 12:21What we know,
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12:21 - 12:23what we have proven,
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12:23 - 12:26is that this conversation
needs to happen today -- -
12:27 - 12:29not next week, not next year.
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12:29 - 12:32What is at stake is our lives today
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12:32 - 12:34and the lives of us as we get older
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12:34 - 12:36and the lives of our children
and our grandchildren. -
12:37 - 12:39Not just in that hospital room
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12:39 - 12:41or on the couch at home,
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12:41 - 12:44but everywhere we go
and everything we see. -
12:45 - 12:51Palliative medicine is the answer
to engage with human beings, -
12:51 - 12:54to change the journey
that we will all face, -
12:55 - 12:57and change it for the better.
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12:59 - 13:01To my colleagues,
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13:02 - 13:03to my patients,
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13:04 - 13:05to my government,
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13:05 - 13:07to all human beings,
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13:07 - 13:11I ask that we stand and we
shout and we demand -
13:12 - 13:13the best care possible,
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13:14 - 13:17so that we can live better today
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13:17 - 13:18and ensure a better life tomorrow.
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13:18 - 13:20We need to shift today
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13:21 - 13:24so that we can live tomorrow.
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13:26 - 13:27Thank you very much.
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13:27 - 13:28(Applause)
- Title:
- What we can do to die well | Timothy Ihrig | TEDxDesMoines
- Description:
-
The healthcare industry in America is so focused on pathology, surgery and pharmacology -- on what doctors "do" to patients -- that it often overlooks the values of the human beings it's supposed to care for. Palliative care physician Timothy Ihrig explains the benefits of a different approach, one that fosters a patient's overall quality of life and navigates serious illness from diagnosis to death with dignity and compassion.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 13:30
TED Translators admin edited English subtitles for What we can do to die well | Timothy Ihrig | TEDxDesMoines | ||
TED Translators admin edited English subtitles for What we can do to die well | Timothy Ihrig | TEDxDesMoines | ||
TED Translators admin edited English subtitles for What we can do to die well | Timothy Ihrig | TEDxDesMoines |