Hamblin: Some of these practices might feel clearly archaic to readers, but it really wasn’t long ago. Is the controlling doctor a relic, or should expertise sometimes still overrule patients and their families? Is it possible to know what’s best for another person?
Lerner: That arc has been going on for a long time, that shift from paternalism to autonomy. If anything, I think I see almost a desperation among doctors and patients for more-meaningful interactions in an era in which time with patients is so limited, and technology is so important, and there’s all these algorithms of care. I really sense a desire from my colleagues, for example, let alone the patients, to really try to interact with one another in a way that goes beyond the science. That is a way to hearken back to my dad’s career. He was good at the science, too, but it was all about the intangibles, the art of medicine and knowing your patients and tailoring treatments to individual patients and wanting to do what was best for them. It was a good opportunity for me to look back on that period of medicine and see if there are lessons we can draw on now.
Hamblin: At that time, doctors were calling shots for the patients, but at the same time they probably had more time to really know the patients’ personalities and be better able to predict what they would want for themselves.
Lerner: Absolutely. For good and bad, but mostly for good. Time’s a huge barrier these days.
Hamblin: And it seems like that’s only going to get worse as we have this increasing physician shortage.
Lerner: One bit of optimism I have is about all of the modern efforts to transfer to models where doctors are part of teams—there are nurse practitioners and nutritionists and social workers who can maybe do some of the legwork and paperwork and other things they’re skilled at to at least theoretically free up the doctors to do more doctoring. At least in theory. That’s the cup half-full version.
Hamblin: You dealt with end-of-life care with your father with Parkinson’s disease. Had you gone through these journals extensively at that point; was that in your mind when you were making these decisions?
Lerner: Yes. I guess I was the main person by dint of the fact that I was a doctor. I think that my mother and my sister in particular deferred to me. I have an uncle who’s a doctor also. But it was logical given that this is what I do for a living, that I would be the main person, and, as you suggested, having been immersed in his journals for so long. So I was very cognizant of his very vehement views about death and dying.
He had become an ardent foe of prolonging the lives of people who were gravely ill. As an infectious diseases doctor, he wound up doing consults on patients from nursing homes and with dementia and terminal cancer and they would come into the hospital and get infection after infection, and he would treat them with this antibiotic and that antibiotic, and for what purpose?