D is for Doctors, Diagnosis, and Decisions – #AtoZChallenge 2018
I hate to break this news to the world (or at least those visiting this blog) but doctors are mere mortals. They are not the deities that they were once revered to be. This isn’t to say that they aren’t extremely important and that they don’t hold an extremely important role in our team of healthcare professionals, but they are just that, a member of the team. Yes they may have the ultimate decision-making ability regarding diagnosis and treatment, but that should be, and in ideal scenarios is only after careful examination, consideration, and discussion with the patient and any other pertinent members of that patient’s healthcare team.
Let’s return to the aspect of the physician being one member of the team. It is extremely important to realize that you, as the patient, are also a valued member of that treatment team. You should be directly involved in any discussions regarding diagnosis, treatment options, and decisions regarding your care. It all comes down to communication. You might wonder why you should be consulted, for instance, when you have clearly broken your leg, and all you want is for them to fix it. Let me see if I can clarify this for you.
Option 1: The physician walks into your exam room and says okay, the x-ray shows what we thought. You did break X bone in your leg. We’re going to cast it for 6 to 8 weeks and give you crutches, then you’ll be fine. That’s certainly one way of accomplishing the task of treating your broken leg. However, let’s look at another example of how the same outcome could be accomplished in more of a partnership discussion.
Option 2: The physician comes into your exam room, sits down and explains that yes, his initial impression was right. You did, in fact, break your leg. Then he logs into the computer and shows you the x-rays of your leg and explains where and how you broke it, and your options for treatment, as some fractures may have multiple treatment options with varying risk/benefit scenarios. But let’s say yours is a simple break, as he explains to you. He can either cast it or put you in what’s commonly called a boot, which you may take off very briefly for bathing only, but either way you will not be permitted to put any weight on that injured leg for at least 6 to 8 weeks when it will be re-examined to determine if it has healed enough.
Once the cast comes off, it will likely feel very stiff and sore as the joint has been immobilized that entire time. As a result of this and the injury itself, you will likely need physical therapy for another 4 to 6 weeks once the cast is removed, during which they will permit you to slowly start putting weight on it again in stages, as tolerated, to prevent re-injury or further injury. Once this is all done it should be back to its pre-injury state save the fact that you’ll probably know when it’s going to rain as discomfort or even pain in your leg where it was injured.
Which of these two examples gives you, as the patient, the most complete and accurate picture of what is needed to properly treat your fractured leg and what will occur during and after treatment until you have fully recovered? Which gives you the best idea of what to expect and try to prepare yourself for?
Maybe you know that despite being told not to walk or put any weight on it, if you have the boot, you will walk on it. You can discuss with the doctor your concern and together you can all decide how to best proceed. Most physicians welcome the opportunity to have two-way dialog with their patients about their care. After all isn’t their goal to provide you with the best possible care?
Perhaps you read the above example of a broken leg and thought to yourself it’s just a broken leg, just fix it. However, before you mock my logic let’s look at another very plausible scenario which could also quite easily occur.
You’ve been diagnosed with a type of cancer that can either be extremely aggressive or very treatable depending upon the specific results of the tests and biopsies. In the visit with the oncologist (cancer physician) to determine the best course of treatment and discuss your prognosis, there are two ways it could go.
Option 1: The doctor could walk in and say this is what we’re going to do. We’re going to give you this chemotherapy drug so many times a week for two or three months. After which you’ll get radiation treatments for another 6 to 8 weeks. If you have any questions I’ll see you in a month for your first follow up, then they leave the room.
Option 2: The doctor could come in and discuss, in whatever level of detail you prefer, the results of your imaging studies, biopsies, and lab work. They can present you with the known facts about your specific type of cancer including preferred treatment options that typically result in the best outcomes, and what those ‘best outcomes’ may be. Maybe for your cancer, the ‘best outcome’ is a 15 to 20 percent chance of adding three months to your life, but death is a certainty. The side effects of the chemotherapeutic drugs are very severe on your body and will almost certainly make you vomit constantly leave you nauseated when you aren’t vomiting, and likely leave you so fatigued you will be unwilling or maybe even unable to get out of bed.
I know you’re saying this is a cruel, inhumane and horrible example to use and yes, cancer is a horrible disease. Practically speaking which scenario of the conversation with the physician provides you with the clearest, best, and most complete information with which to make a decision about how to treat your cancer?
Though the second one sounds grim and potentially pessimistic or even defeatist let me tell you that having been in this situation with someone extremely close to me I wish they had told us all these details and for that person to have had the ability to decide how he wanted to spend his remaining time instead of pumping sunshine up his rectum insisting it was all going to be okay.
It’s perfectly acceptable if you disagree with me, or don’t like my opinions on the matter. All I ask is that you honestly and sincerely stop to think for a moment before you pass judgment on the cancer scenario. Which would you prefer if it was your spouse, child, loved one, etcetera?
In closing the way the doctor-patient relationship has morphed over the years are too complex to cover in this brief post. However, both the physicians and us as patients need to learn to take a more active role in the partnership between doctor and patient and practice good, honest and open communication in order to achieve the highest level of care and best possible outcomes.
What are your thoughts on the matter? Would you rather simply be told what to do, or would you prefer to be a part of the treatment process?
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