The Best Care Possible

By Ira Byock, MD

The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life (available March 15, 2012) prompts readers to draw contemporary conclusions regarding end-of-life considerations. Byock’s narrative detailing the terminal journeys of several patients outlines the difficult choices between quality and quantity of life; the treatment conundrums physicians and patients sometimes face; and the qualities of compassion, empathy, kindness, and understanding that help physicians facilitate intractable decisions at the end of life.

Byock, a leading expert in palliative care, showcases the options palliative care offers patients without hope of cure or recovery. He details ways in which he and his team provide treatment for pain and symptoms, offer support to patients and family members, present information to assist in decision making, provide emotional and spiritual support, and help patients (or their families) navigate the healthcare system.

The book’s contention is that at a time when technology and medical advancements have developed the capability to prolong life, doing so isn’t always the best option. It calls on our 21st century society to undergo a paradigm shift in its views and treatments in end-of-life care.

In the chapter titled “What Are Doctors For?”, Byock presents medical students in a learning forum with an illness-as-a-journey metaphor: “When a patient is dying, accompanying entails walking with a person on a journey that ends in the person’s death. Accompanying implies that we physicians will not abandon a person who makes a treatment decision with which we disagree. It may be that a patient refuses a treatment we think she really should have, or that a patient demands an operation or course of treatment that is not in her best interests. My consistent stance is: I am here to serve.”

Byock’s compelling and touching vignettes chronicling patients’ final journeys and the weighty considerations they face showcase professionals’ humane and insightful characteristics that contribute to palliative care’s efficacy. The palliative care team provides the hope of a “good” death when healing and cures are impossible. Byock effectively shows the human, caring, compassionate side to professionals’ role in palliative care that is sometimes the best medicine can offer.