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We need to talk

While they are necessary, end-of-life conversations are seldom discussed. Such silence is understandable when it comes to the general public, but it's outright puzzling in terms of public health policy.

That is why this Advisory Board article is so important. It sheds light on the need for end-of-life conversations, which are in many ways the key to improving healthcare. The article points patients toward the information they need and outlines how they can better understand their care choices.

Helping patients get informed is at the core of these conversations -- and it's at the core of improving healthcare, too. Of course, most patients (and physicians) are not eager to have an end-of-life (EOL) conversation. Part of that is due to human nature, but part of that is also due to how the health system operates.

Few realize that our healthcare system is designed to keep patients in the dark about their care options. In other words, ignorance is a feature of the system, not a flaw.

Just look at the incentive structure. The health system does not reward physicians for having such discussions. Similarly, palliative care and hospice -- which are crucial alternatives for EOL care -- are difficult to access and often off the table. And while these options may be available at the very end, at that point their value is limited.

In sum, we need to pay much greater attention to EOL care. My forthcoming book, The Journey’s End, makes the case for this because these critical conversations cannot wait.

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