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The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life

4.28  ·  Rating details ·  366 ratings  ·  59 reviews

A palliative care doctor on the front lines of hospital care illuminates one of the most important and controversial ethical issues of our time on his quest to transform care through the end of life.

It is harder to die in this country than ever before. Statistics show that the vast majority of Americans would prefer to die at home, yet many of us spend our last days

Hardcover, 336 pages
Published March 15th 2012 by Avery
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Meghan Poperowitz
Apr 03, 2013 rated it it was amazing
I may be biased because I have had the opportunity to work with Dr. Byock and his team at Dartmouth- he and his team are some very special people. I may also be biased because I focus on and promote Palliative care in my practice as a staff nurse. However, this is an excellent read for both practitioners and lay people on prioritizing PEOPLE in healthcare not diagnosis a by providing the best care possible - especially leading to and during the last phase of one's life. I recommend ALL his books ...more
Steven Chang
Jul 15, 2013 rated it it was amazing
A MUST read for any future physicians, pre-health students, or anyone that is interested in a career that deals with patients. Byock understands exactly what this generation has become and what it needs to be regarding care for terminal patients. He shares many stories and examples of what it truly means to care for a patient. Countless times, we hear physicians say, "I'm sorry, there is nothing more we can do to help your illness." Byock argues that should NOT be the case for any physician beca ...more
Jun 15, 2012 rated it it was amazing
Dr. Byock is the head of the department of palliative care at Dartmouth-Hitchcock Medical Center and a professor at the associated medical school. This means he has dealt with a lot of patients who are reaching the end of their lives; his job is to make that end as comfortable and stress free as possible for both them and their families. It is his contention that Americans today suffer more and die worse deaths- and more expensive deaths- than ever before. How is this possible in an age when the ...more
Lisa Shultz
Jan 11, 2017 rated it it was amazing
Shelves: end-of-life
Ira Byock, MD has written another gem of a book. If you don't understand the power of palliative care to foster quality life, comfort at the end of life, and the prospect of gentle death, this book will illuminate you. Filled with patient stories that show how addressing death and working together to achieve a peaceful end of life is possible and can create healing and closure.
The end of the book is a strong call to transform the way we die in America. The author feels that "How we die is alrea
May 09, 2012 rated it liked it
I didn't read the entire book--just skipped here & there; what I did read was interesting.
Our country is messed up when it comes to medical care.
Don't ever think that your advance directive will be followed--or even looked at.
Always have a family member present when your care is not acceptable; have them stay with you
until the care is acceptable--whether in the hospital or a nursing home.

If your doctor leaves the exam room before answering all your questions, stay put.
They will need the room so
Mar 05, 2018 rated it really liked it
Written by one of the leaders in the Palliative Care field, this writer is a good story-teller, and tells the reader interesting and illustrative stories about some of his dying patients. Probably the most salient and astonishing point he makes in the book, is that patients, facing a life-threatening illness, who tell their doctors to do "whatever it takes, at all costs", in order to prolong their life, statistically, don't live as long as patients who tell their doctors to make them as comforta ...more
Kathleen Ambrose
May 28, 2019 rated it it was amazing
Shelves: end-of-life
This is an excellent book! Palliative care and hospice care are differentiated and at the same time shown to be unified in their goal to provide the means for the best care possible in the end of life.
Seven years after this book was published, there are many more discussions, more books published and more palliative-hospice programs being developed. I wonder how many were indirectly fruits of this work.
I particularly liked hearing the stories of the different patients and Dr. Byock’s compassio
Mar 23, 2020 added it
I couldn't get through series of accounts of patients who are closer to death narrated in a story form. I had read through 30% and couldn't read more, it is not lack of empathy but writing style didn't give that connect you look for when you read a grim book like this. ...more
Oct 02, 2019 rated it it was amazing
Y'all. Please read this. Talk to your loved ones about their frickin wishes for end of life. Use the resources available to have the best care possible and enable your loved ones to die well. ...more
Christine Cazeneuve
Jan 16, 2020 rated it really liked it
Important reading. A detailed and rational look at the end of life care. Very interesting and much food for thought. A very good read.
Carl Kruse
Jan 03, 2021 rated it it was amazing
Looking forward to diving into this book after being highly recommended by a respected friend.

(Rating is one based on pre-interest).
Apr 05, 2016 rated it it was ok  ·  review of another edition
There might be lots of very useful information in this book. The only problem is you need to read the friggin' thing to get to it and I couldn't even get to page 50 before I threw in the towel. Dr. Byock walks a very fine line between explaining how he goes about his business and being a shameless humblebrag.

I wanted to give him the benefit of the doubt because I genuinely respect his line of work and am interested in the subject matter but the I, I, I, me, me, me started causing me to daydream
Aug 22, 2015 rated it it was amazing
This is a perfect companion piece to "Being Mortal," which I recently reviewed. Byork has ideas that should spark reform in this book with a positive and loving message. Everyone should be able to expect humane care and comfort as they reach the end of their lives--and not be subjected to treatment without a substantial possibility of improving the quality of days--not just their quantity.

In Byork's opinion, we'll need almost a revolution to bring Americans to the place where they can accept de
May 20, 2014 rated it liked it
The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life is author and doctor Ira Byock, M.D.’s latest opus on end-of-life care. The palliative care physician’s reflections on being a “doctor to the dying” are an expression of hope, filled with real-life stories of love and strength in the face of impending loss – but they’re also an urgent call to action for medical reform.

Reform for Ira Byock means better doctor-patient/family relationships; it means changing the w
Tiger Gray
I loved this book. Written by a doctor involved in palliative care, it offers many fresh and invaluable perspectives for the care worker. I found the sections on narrative note taking incredibly useful. How to take notes that are realistic and yet empowering towards the patient has long been a topic of debate in the medical world, and having this perspective before I too enter that system is a wonderful thing (I can well remember unfair and stigmatizing notes in my own charts, too).

Secondly, wh
Dorothy Mahoney
Feb 08, 2017 rated it it was amazing
Byock uses many patient examples from years of experience with palliative care. His strong point,
given in his lectures is "alleviating suffering and eliminating the sufferer are very different acts."
He reverts back to before the 1960's when childbirth was considered a medical event and that dying
needs a similar over haul. He advocates music, poetry and stories, and includes Marge Piercy's poem, "To be of Use" and a Franz Kafka poem about the world offering itself at your feet. Communication is k
Mar 20, 2012 rated it really liked it
Too many comments and favorite quotes to include them all here. Standouts:
"...we're just kicking the can down the road."
"Until you're convinced she is safe, don't leave your mother alone."
"dying is hard, but it does not have to be this hard."
"Dying is the most inevitable fact of life.". DUH!!!
I propose that that until we develop a culture of respect for our elderly AND believe aging is a good thing rather than a feared thing, dying and the process of dying will continue to be hard for the dyin
David Ellis
Jun 26, 2012 rated it it was amazing  ·  review of another edition
This book helped me clarify my thinking about end-of-life care and the conversations families need to have before it is too late. Neglecting to carefully make and share specific choices risks subjecting the dying person to multiple, futile resuscitations and prolonged, hopeless lingering before the death finally, inevitably occurs.

This book does not argue for euthanasia or assisted suicide. As the author makes clear, these two controversial issues distract our attention from the values and conce
Aug 03, 2012 rated it really liked it
Shelves: book-group
I heard Dr. Byock on NPR and was really impressed. The book teaches its reader how to improve end-of- life care. The "best care possible" includes life-prolonging treatments, pain management, tenderness, and respect for people's right to say when enough is enough. As a palliative care specialist his suggestions are very practical ones: providing support for caregivers, using hospice sooner, supporting the dying in our communities, making corrections to our healthcare system and doctors' educatio ...more
May 28, 2012 rated it it was amazing
Realistic look at major issue in US health care - allowing patients to die well. Docs trainned to be reactive to diseases/injuries rather than proactive in trying to prevent same. For all our advances, as Dr. Byock says, we will never be able to do away with death. His conclusions:
1. "We must escape our fixation with diseases and health care rather than people's well being."
2. "We must get beyond seeing people solely as individuals/patients and begin seeing people as individuals within families
Feb 06, 2013 rated it liked it
I really enjoyed the first 3/4 of this book, a lot more than I was expecting to. The personal stories of different people and their experience with hospice I found very persuasive and effective. Even if the author did seem a little full of himself about his ability to change people's lives for the better (both his patients and his students)...But then the last section turned to physician assisted suicide and society's obligations as caregivers and etc. I quickly lost interest in reading one doct ...more
Jun 26, 2015 rated it it was amazing
An excellent look at what care for the dying should be, what palliative and hospice care means and why no one should die in the ICU. As a person who worked in the medical field for years, not much of it was new to me but it reaffirmed and added to what I already knew.

Since all of us and all the people we love are going to die, I wish everyone would read at least the first few chapters of this excellent book. Sadly, I think the people who really need to read it the most, especially those who tal
I appreciate the work that went into Ira Byock’s book, “The Best Care Possible.” He is, without a doubt, one of a handful of the absolute top palliative care physicians in the country. Clearly, this is a person committed to his work, and to his patients. If the term, “palliative care” is new to you, then you will have a much more nuanced understanding of what it means by the time you’ve finished this. I find myself comparing this book to Atul Gawande’s “Being Mortal.” For lyricism, Atul is the b ...more
Jessica Bang
Nov 12, 2014 rated it liked it
The urgency for change is what I appreciate here. The anecdotes are (inevitably) touching. That being said, the way the public is told to go about reformation is too broad. To the people who don't know to advocate and vote for politicians effectively (immigrant Americans, younger Americans)? To those whose family's cultural/religious beliefs affect death and dying in much more complicated ways? If anything, this book can spark a lot of discussion. One can only hope things will get done after tal ...more
May 17, 2012 rated it really liked it
I read this book and immediately felt I should reread it. Dr Byock does a great job of sharing his experiences with palliative care and then applying those experiences to the greater health care worls around him. I will be reading other things he has written and reading books he recommended in this book. The more I am part of the end of people's lives, the more I feel like we could do a better job during those last hours, days, or months. ...more
Jul 10, 2012 rated it it was amazing
This book explains what palliative care near the end of life entails, how hospice can improve the quality of life even as one is dying, and the beliefs and laws that make it all more difficult than it needs to be. The author, a physician specializing in palliative care, writes of case studies, and has a good bibliography as well as a list of internet references. I would recommend this book for anyone, but especially those of us who are getting to be close to retirement.
Rev. Deb
Oct 22, 2012 rated it really liked it
Like it or not, no one lives forever. Once you get over that, it's time to think about what choices you want to make for yourself, and which ones you are OK letting others decide for you. Dr. Byock gives simple, clear explanations for things that you don't think about ahead of time, necessarily, when it comes to health care decisions. It's good info for anyone to read, but especially helpful for those of us who work in healthcare. ...more
Samuel Brown
Jul 26, 2012 rated it really liked it
Not quite as good as his earlier _Dying Well_, but Byock continues to exhibit a good mind and a great soul as he works through issues relevant to our current engagement with life near the end of life. We should all be so fortunate as to have a doctor like Ira Byock at our side when it is our time to prepare to leave.
S Beverage
Feb 06, 2013 rated it it was amazing
An important topic that Americans tend to avoid - especially pertinent given what has been going on in my family, and the loss of my father in law.

We need to talk to each other honestly about how we can live our lives well, all the way to the end, and what that means both personally and for us as a society.

Definitely worth reading.
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