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Extreme Measures Book Review

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Book Review:
Extreme Measures by Jessica Nutik Zitter, MD, MPH

Dr. Zitter is board certified in pulmonary/critical care medicine, as well as palliative care medicine. She practices in Oakland, California, and is an active contributor to several popular publications. Her first book, Extreme Measures, was published in 2017 and received positive reviews from The New York Times. According to its critics, “Like Atul Gawande’s ‘Being Mortal,’ Zitter’s book shows how knowing when to do nothing is as vital to being a good doctor as knowing when to do everything.”  

Extreme Measures takes us on a journey through the author’s early career in critical care medicine. The work is attentive and introspective. Dr. Zitter interacts tenderly with the patients profiled in the book. Eventually, one of those patients is her elderly grandmother. She also reflects deeply on her choice of becoming a doctor, and like many she sensed a higher calling in service of others.

Processing several years’ experience in the ER and ICU, the book presents a strong critique of the American health care system. Dr. Zitter shares her views of some of its pitfalls and challenges. Ultimately, she will argue for a change in the way the U.S. deals with death and dying.

Mini-histories of medicine are referenced throughout the work, including innovations in medical devices and in academia. Dr. Zitter notes relevant medical literature, as well, such as a pair of studies in JAMA comparing physician deaths to the general population. In those papers, doctors avoided extreme measures themselves, preferring to die in the comfort of their homes and surrounded by loved ones. A few other important themes and concepts are: shared decision making between the provider and patient, distress and burnout in the ICU, and a team-based approach to medical care.

Regardless of their connection to the respiratory field, readers are left considering the ramifications of prolonging a life. Is it always an appropriate response, or are there more instances where we should avoid extreme measures?

Extremis, Jessica Zitter’s award-winning documentary short, now available on Netflix – view the trailer

Editor’s note: The ATS does not endorse any of the programs or products mentioned in this column.