Dr. Karol Watson, cont'd

Dr. Karol Watson

Interviewer: 100 years ago I believe the life span was 47 years old for the American and now it's in the 80's. Can you talk about what that means to our population and what that means to individuals?

I think the patterns of behavior that were established 50 years ago and the things we did as youngsters, young adults, elderly were different and it probably was okay that they were different. When women were dying at age 30 it was probably okay that they got married at age 15 and had kids at age 16. But now that women are living to age 75-80 that doesn't make much since so I think the patterns of behaviors have changed as our life expectancy has changed.

But other patterns of behavior really haven't changed as much. Things like, there's a sort of feeling of invincibility when you're young and that makes a lot of sense if you don't know what tomorrow's going to bring. If you think that if maybe in 10 years you're going to be dead anyhow, but when you're trying to keep somebody alive for 80-90 years and not just keep them alive, but keep them well and alive, our patterns of behavior need to change. We need to do things in our 30's and 40's that are very different from maybe what we did 50 years ago.

Interviewer: What does the phrase "caregiving" mean to you?

To me it means not only making patients live longer, but making them live better and keeping them well for the time that they're alive. So in order to give care to a patient I think that also means a very different thing in terms of what the patient wants. So there are many things I can do in medicine and there are many things I can do to keep you alive for a long time, but if that's not what a patient wants then that's not giving them care. That's actually the exact opposite of caring for them. I need to figure out what is important for them.

For many patients living an extra five years is not important but making sure they're able to live independently is important and that can be a very different set of interventions that I do in that case. So, to me, caregiving means taking into account what the patient wants and to helping them live the kind of life that they want to live for as long as they can.

Interviewer: How do you interact with the family and dealing with a patient? How important is the family?

The family is critical. Particularly as we age, many of my patients are under the care of their family members, so any decisions that are made have to be made in conjunction with the family and that can really be a mixed bag. There are so many different family dynamics and to dissect them all, to actually see the insight into all of them is important.

Interviewer: When is enough, enough. Let's say you've got a 88 year old patient and you know that it's going to be difficult. How do you deal with that critical issue, that challenge of communicating your ideas, understanding what the patient wants, understanding what the family wants?

One of the most difficult things is actually understanding what the patient wants because so many things come in to play. It's understanding what the patient wants, not what the family wants. And what the patient wants for themselves, not what they think their family wants them to say and that can be quite difficult.

So in addition to figuring what the patient wants there's the issue of medical futility. We can't, it's not right, morally or professionally to offer interventions to patients that we know will give them nothing but suffering, will not improve their quality of life and will not improve the length of their life. But many patients hold onto hope and that has to be balanced by reality.

Next: The heart of the matter