Customer Reviews: The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life
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on March 20, 2012
This book is not intended for everyone. Just for those of us with an ailing loved one, or a loved one who who is dying. Or those of us who may at some time have an ailing loved one, or a loved one who may die. Or those of us who may at some time ourselves be ailing or dying. Dr Byock transforms the discussion of how we live our final days from a political hot potato to a rational, personal and heartfelt fact of life. As a physician, I am keenly aware of the miraculous medical tools that we as Americans are fortunate to have available to us. I am equally aware, however how the inappropriate use of these tools can contradict our ultimate responsibility as physicians to "above all do no harm". More importantly, as the son of one of the patients whose journey through critical illness and hospice care is chronicled in The Best Care Possible, I have witnessed and experienced how an informed and caring medical team can positively effect not only the patient, but those who love her as well. Let the publication of this book awaken us all to the need for a national discussion, in a sane and rational way, of the need of advanced directives, and an assessment of how we choose to spend our final days. Sanford E Glikin, MD
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Dr Ira Byock's new book, "The Best Care Possible" is one doctor's look at the inevitability we all face - death. Like taxes, death is a by-product of life and a "good death", while seemingly an oxymoron, is something Dr Byock has been writing about for many years. An "end-of-life" specialist at New Hampshire's Dartmouth-Hitchcock Medical Center, Ira Byock works with a team to put together as good and gentle a death experience as possible for his patients.

Byock writes, that as we baby-boomers age, we're facing both the inevitable deaths of two generations - our parents, and then, in our turn, ourselves. As overall medical treatments advance, we're living longer and what used to kill us at earlier ages, doesn't do that so much anymore. And we're not dying as often in a family-setting. Most deaths occur in hospitals and nursing homes, with the dying tied up to machines that often keep them alive far past the point most people want to be kept alive. The old conundrum of "quality of life" vs "quantity of life".

Dr Byock's book is not a "how-to" guide to making a "good death". There are no steps he advises taking, but rather he speaks to the larger issue, from both a medical standpoint and a personal one. As a doctor in a smallish community, Byock often has to look at both views when treating his patients. He writes about teaching medical students at Dartmouth Medical School to be aware of the responsibilities as future doctors when medical treatments fail at arresting illness and the patient moves on toward death. And when advanced chemo might be granting a cancer patient a somewhat longer life span but at the cost of agonising side effects. When does a "good life" sequence into a "good death"? How does the doctor, his or her support staff, and the patient's family and friends make that "good death" occur? He's a long-time believer in hospice.

I think Dr Byock has written a few books on the subject of dying. This is the first one I've read, but not the last one. He asks questions of the reader in subtle ways that make the reader look past the often first and easy answers, to the tougher ones. But those are the answers that need to be thought about in end-of-life issues.
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on March 24, 2012
I wish I could send a copy of this to my mother, an RN who loved Dr. Byock's work and died 6 years ago... This book has changed the way I think about hospice and palliative medicine, not a minor accomplishment as I have been practicing this subspecialty since 1988, before it officially even existed.

Dr. Byock's earlier book "Dying Well" was a revelation to me because it held up a mirror, convinced me of the terrific potential of the work I had just begun doing and let me share that with others; "The Best Care Possible" holds such a mirror up to the whole country, showing us as a nation where we are failing to provide the care needed by the seriously ill, and how we can transform that, not only to benefit the suffering but to change the system.

Patrick Clary, MD
Exeter, New Hampshire
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on April 22, 2012
The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life

There is a first time for everything, inclusive of posting comments to Amazon. Despite many years of online buying and hundreds of purchases, I admit to not having left a comment--until now. It's about time. Dr. Byock is compelling.

I literally know of no colleague in the field of bioethics who would admit to not having read Ira Byock's first book, Dying Well. It already has become a classic in our field. Dr. Byock's third book may well become another of that sort. He writes that well.

Who among us doesn't long for "the best care possible" when in need of health care for ourselves and those we love? The medical students and residents I teach and providers for whom I consult all strive for excellence in that regard. Why then does it elude us as a society? Why do so many of our elders and children still slip through the cracks of a notoriously expensive healthcare system with some of the best facilities and resources in the world? It is something of an enigma. Ira Byock is one of few people I know who can take this on with integrity and intelligence, grounded in decades of hands on, in the trenches, clinical experience.

We all have read and heard enough nonsense during recent years of highly politicized "healthcare reform" debates. It is refreshing then to read something provocative that also makes good sense. Byock tells a good story, of course. "Masterful" is the adjective that comes to mind. But this book is more than gripping narrative. It is an insightful ethics analysis and a rational policy proposal. In the end, what it boils down to, is . . . love. Dr. Byock makes a non-religious moral case for teaching, practicing, and affirming love in healthcare.

"Love is, after all, the primal impetus and sustaining force of all the caring professions. There is nothing unethical or unseemly about loving our patients" (p. 284). The preacher in me (or is it the patient?) wants to shout, "Amen!"

"Love is not all we need--science, technology, good judgment, and sound policy are also required--but without love we are without hope of fixing this crisis" (p. 285). To which the ethicist in me also says, "Amen."

Tarris Rosell, PhD, DMin
Center for Practical Bioethics
Kansas City, MO
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on June 11, 2012
I work with Dr. Byock and can tell you every patient who is facing cancer or any critical health crisis should be cared for by him and his team. As a volunteer in his Palliative Care Program, I see first hand his goals of not only good care and pain management, but his fervent wish that each patient be treated with the dignity and grace they deserve in what might be their last days. He has assembled an amazing team to make sure his goal is achieved, from nurses, doctors, social workers, chaplains and us, the volunteers who can make a difference just because we can take extra time and spend it with the patients and families.If I had the power, I would give him the Nobel Peace prize for the humanity he shows every patients and family and they make some very difficult decisions with each patient and they prepare for what is so often the approaching end of life. An extremely well written book which will show what I am referring to regarding Dr. Byock being the model for every Doctor leading a Palliative team.
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on April 7, 2012
For anyone of any age thinking of the issue of quality vs. quantity in life, Dr. Byock's book is worth reading. I've often wondered whether Americans' greatest strength - the boundless optimism and can-do attitude - actually works as a liability when it comes to accepting the inevitable. Because accepting death is seen as conceding defeat, might people insist on spending fruitlessly in search of cure for the incurable, thus exacerbating our current healthcare crisis? Dr. Byock's book thoughtfully explains the alternative and how going with hospice and palliative care may help to give the patients and their families time to grieve and bond, the time which might otherwise be lost if they were to endure endless cycles of painful surgeries and chemotherapy. I recommend the book to everyone, whether one is healthy or ill, because we'll all have to make the decision sometime in our lives.
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on July 9, 2012
This book helped me clarify my thinking about end-of-life care and the conversations families need to have before it is too late. Neglecting to carefully make and share specific choices risks subjecting the dying person to multiple, futile resuscitations and prolonged, hopeless lingering before the death finally, inevitably occurs.

This book does not argue for euthanasia or assisted suicide. As the author makes clear, these two controversial issues distract our attention from the values and concerns we share about living a good life that ends with a dignified, gentle death. Whatever your position on those topics (the author calls himself 'pro-life' and explains why he does not agree with physicians practising euthanasia or assisted suicide) you will find yourself sharing many of the author's concerns and values on the vital topic of end-of-life care.
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on May 28, 2012
This book should be read by EVERYONE. Dr. Byock pulls no punches. Every dilemma: technological, bureaucratic, political, even religious is openly discussed as well as our medical dilemmas and the eternal unknown about how things will turn out. This is done exquisitely, like a fine painting. One is there in the presence of the hospital, the ICU, the hospice, the patients bedside, the caregivers, the grieving family. Every doctor, regardless of training, specialty, personality or style of practice must read this book. All the "white coat" protections, barriers, and resistances fall away, and the real possibility of healing , life and death, is left , naked, exposed, fragile, and inscrutable--- and what remains is the possibility of "Best Care". George Keeler M.D. FAAFP
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VINE VOICEon June 15, 2012
Dr. Byock is the head of the department of palliative care at Dartmouth-Hitchcock Medical Center and a professor at the associated medical school. This means he has dealt with a lot of patients who are reaching the end of their lives; his job is to make that end as comfortable and stress free as possible for both them and their families. It is his contention that Americans today suffer more and die worse deaths- and more expensive deaths- than ever before. How is this possible in an age when there are so many medical treatments available?

Part of it is that the patients don't make their wishes known via advance directives. If a person comes into a hospital without one, and they are unable to make their wishes known, the hospital has the right and obligation to do everything they can to prolong life. While this is absolutely the right thing to do most of the time, it isn't always what the person really wants. When a person is near death from cancer, say, and takes a fall that creates a brain bleed, the hospital will put them on life support and prolong their life, even if there is no chance of recovery. Would that person have wanted that, or would they prefer to let go at that point? Who wants to live another 2 weeks if they are intubated, on a ventilator and semi-conscious at best? But doctors have an obligation to preserve life, and the family feels guilty if they say `pull the plug'.

Add to this problem the fact that doctors get almost no training in palliative care and end of life issues. Many don't know the best ways to deal with pain and fear, or even how to broach the subject of impending death. Some even hesitate to prescribe opiates because they are addictive- as if that could possibly be an issue for a dying person. These things need to be addressed in medical school. Medicare adds to the problem by not paying for palliative care or hospice care if the patient is still being treated for their health problem; I know from experience that some of these treatments should NOT be considered as trying to cure the patient but rather offering a better quality to their remaining life.

This book achieved what I would have thought impossible: it's both very difficult to read, because the subject matter is emotional and painful for someone who has dealt with end of life issues, but easy to read because of Dr. Byock's talent with words. He includes medical details but at a level that is understandable to all; he includes details about death that don't gross a sensitive person out. I hope that this book gets very widely read by both doctors and lay people; having gone through five deaths in our families it would have been much easier on us as family and on the patients if we'd known a lot of what is in this book way ahead of time- and if the doctors had been more comfortable dealing with end of life.
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on June 20, 2012
I wrote "required reading" above because I believe this book deals with events that most people tend to ignore until it is too late. End of life issues. Unless you die in an accident or suicide, chances are you and/or your family will have to make decisions about what is to happen at the end of your life. This book explains in very easy to understand language what the issues and the options are. There are no hard and fast answers to these questions, but the author gives us a way to think about them by using many case histories and examples taken from his many years of experience. A thorough, compassionate discussion of how to prepare for the last phase of life for yourself and for those you love who may be in your care.

Very worthwhile and highly recommended.
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