Handbook for Mortals : Hastening Death : Finding a doctor you trust

If you are fortunate, you will have doctors, nurses, and others who are easy to trust. Maybe you've known them for years, or maybe you have needed them urgently and they have always come through. But you may feel uncertain. You may have no regular doctor or nurse, or you may have needed help badly at some time and they let you down, or you may have heard stories of bad care. What can you do?

First, trust and confidence don't usually arise immediately. Talking about your fears and being well-informed are helpful. With serious illness, there are some special fears worth noting. First, morphine and other opioid medicines are very useful and very safe. When your doctor starts using them, death may still be far off, and using these medications usually prolong life. Higher doses of morphine or other opioids may well be needed near death, but there is no evidence that using enough to stop suffering also causes death.

Second, despite the current changes in health care, doctors are still well-protected from the costs of your care. Some people have come to fear that new health payment arrangements make doctors prone to resenting patients whose needs lead to big bills. If you are worried about this in your situation, try to talk with your doctor or with a social worker or chaplain. Perhaps they can show you that the care your doctor is recommending is the same as doctors generally recommend for people with better insurance. Perhaps they can help by talking frankly about the limits that your financial situation does create.

Finally, though, it is reassuring to know that the conflicts over expensive care have mostly been about particularly high-cost procedures, which are very rarely an issue for people who face serious and eventually fatal illness. For most care, doctors and nurses seem generally to be providing about the same care to rich and poor, and to persons of different social and ethnic groups. Remember, doctors and nurses are people who chose a career in serving the sick.

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Handbook for Mortals book cover Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission. To learn more about improving care at the end of life visit the main web site for Americans for Better Care of the Dying.
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