In his 2014 Reith lecture Series, Dr Atul Gawande explores the nature and progress of failure in medicine. I listened to the lectures on recommendation from a friend and was struck by how neatly the points being made by Dr Gawande applied to the financial planning profession and financial services generally.
In his third lecture “The Problem of Hubris” Dr Gawande tells the story of Peg, his daughter’s piano teacher, her battle with terminal cancer and how she chooses to spend her final days. Speaking specifically about his experience of patients with incurable cancer, he talks of how “In medicine and society it seems we have failed to realise that people have priorities they wish to serve rather than just living longer.”
Those priorities will be different for everyone, for example time at home with loved ones rather than being hooked up to hospital machines, preserving mental function, or being able to teach piano – as was the case for Peg.
Change just a few words of Dr Gawande’s statement and you get – “In financial services it seems we have failed to realise that people have priorities they wish to serve rather than just accumulating more money. “
In Dr Gawande’s experience only 1/3rd of terminal cancer patients had been asked about priorities and goals for end of life. What is the equivalent figure for clients of financial services providers in relation to their goals and priorities for life?
Dr Gawande goes on to describe how when patients focus on what is worth living for and preserve it, they get stronger.
He cites a study of incurable lung cancer patients at Massachusetts general hospital, the patients lived on average just 11 months. All of the patients received the usual oncology care, but half of them also saw a palliative care physician to discuss their priorities and goals for the end of life.
The group who had that discussion ended up choosing to stop chemotherapy sooner, they spent 1/3rd fewer days in hospital and were much less likely to die there, they started hospice earlier and had less suffering at the end of life.
And the most staggering statistic – they lived 25 percent longer.
Dr Gawande is right in saying that if this was a drug, it would be a multi-billion dollar drug. But it’s not a drug, it’s a conversation, a conversation about what’s important, exploring what matters most to people in their lives and using our capabilities to protect the priorities people have.