Today SevenPonds concludes our interview with Dr. Jessica Nutik-Zitter, M.D. Dr. Zitter is a board certified specialist in both critical care and hospice and palliative medicine and an attending physician in the intensive care unit at Highland Hospital in Oakland, California. She was featured in the award-winning Netflix documentary “Extremis” and is the author of the recently released book “Extreme Measures: Finding a Better Path to the End of Life.”

Kathleen: Do you believe that physicians have an obligation to offer every life-saving option to every patient, regardless of whether the patient will benefit or not? In other words, should the decision to pursue extreme measures be in the hands of patients and families or should doctors decide?

Dr. Nutik-Zitter: I don’t believe that patients should be put in the position of making medical decisions, no. They should be part of the decision making process, but we doctors went to medical school. We’re the experts, at least in the patient’s disease. But the patients are the experts on their lives and their values and what’s important to them.

The way to bring those pieces of the puzzle together is to have open conversations about expectations, preferences and goals of care. That means doctors must be open and honest about the potential benefits and harms of any proposed treatment, and patients and their surrogates must be willing to hear the truth. It means looking at the disease trajectory and knowing when the time has come to shift gears. I find that treatment decisions become easier when they’re approached in this way.

Kathleen: So, it really is about having hard conversations.

Dr. Zitter: Yes, and also acknowledging that they are hard. We tend to see these discussions through the patient’s eyes, which is certainly appropriate. The patient should be the focus in all care decisions. But these discussions are incredibly stressful for doctors, too. Physicians are not taught anywhere in their education how to talk to patients about end-of-life goals. (…) Read Full Publication Here

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