Tuesday, December 29, 2009

A few more from the NYT

A few more articles, to round out my inter-holiday week of posting about NYT articles to do with end of life care:

1. Last week was an article challenging the idea that more money spent at the end of life does not improve outcomes (ie the Dartmouth Atlas data on Medicare spending). It specifically looks at some data from Los Angeles area hospitals to do with congestive heart failure patients which indicates that those hospitals which spent the most on heart failure patients had the lowest mortality rates. What I found most notable about this was that it addresses to an extent the very important issue of comparing mortality follow-back studies (ie studies looking only at those patients who have died) with studies of the dying/those at high risk of death. These are different groups of patients, and can generate quite convergent results (see here for a more complete discussion of this).

2. There is a book review of The Other Side of Sadness - a look at the science of bereavement.

His conclusion: the bereaved are far more resilient than anyone — including Freud, and the bereaved themselves — would ever have imagined.

{...] When the worst possible news breaks, you will almost certainly get through it unscathed. Almost everyone does. And if your friends and neighbors mutter that you aren’t grieving normally, don’t worry; you probably are.

In other cultures, Dr. Bonanno points out, it is the ceremonies of death that are the focus of public attention; the community makes sure they are carried out with precision. In our own navel-inspecting society, it is the emotions of death that well-meaning observers focus on instead. Why isn’t that widow shedding at least one little tear? How could the boyfriend be off at the ballgame like that? What is wrong with that bizarrely cheerful orphaned child? Surely they all need therapy.

Not so, Dr. Bonanno maintains. In contrast to the grim slog of Freudian grief work, the natural sadness that actually follows a death is not a thick soup of tears and depression. People can be sad at times, fine at other times. The level of fluctuation is “nothing short of spectacular”; the prevalence of joy is “striking.”

Over all, we are hard-wired to move on, helped by innate mechanisms that may seem maladaptive or abnormal but are actually quite common and effective.

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