Sunday, July 20, 2014

How to Tell Someone She is Dying

There is an interesting article with the above title in “The New Yorker” about doctor-patient relationships. It concerns how to get a patient who is in denial or uncomfortable with a certain treatment, in this case chemotherapy, to consider the alternatives.  As a cancer patient, I want to feel in control of my options. Not being a medical expert, I don’t know the pros and cons of different treatments.  I need to rely on my doctors to give me their opinion on what I should do but also the rationale for that course of action.  This was not always the way patients were treated. The article states in part:

“As recently as the nineteen-seventies, medical decision-making in the United States was largely a doctor-knows-best endeavor. Physicians dictated clinical care without feeling compelled to tell patients about their treatment alternatives. Frequently, in fact, they did not even inform patients of their diagnoses.

Medical practice has since undergone a paradigm shift. Physicians now recognize that patients not only have both the right to information but also the right to refuse medical care. Yet doctors are rarely taught how to partner effectively with patients in making important medical decisions. There is a need for a balance between helping patients make wise choices and respecting their rights to refuse medical interventions.

This raises a fundamental question about the doctor-patient relationship: Is modern medical practice all about 'patient knows best’?  Or do physicians still need, on occasion, to cajole their patients into doing the right thing?

Most well-trained physicians believe that it would be a dereliction of their duties to act merely as information providers, standing aside while patients make bad decisions. Experience provides them with an important perspective to guide treatment decisions. Yet a purely medical perspective can cause physicians to lose themselves in details and lose sight of the more human element of patient care such as whether the chemotherapy that shrank the tumor would improve the patient’s quality of life.”

Only a patient can determine the balance they prefer between the quantity and quality of life they want.  As cancer treatment becomes more advanced, options can become less clear in their ability to produce a high quality life.  I would hope that my doctor would understand my preferences and give me the best option to keep my quality of life - even if that means no treatment or palliative care instead of intensive medical therapies that would cause harm.

The link to the article is below:


4 comments:

  1. Hi Beth,

    When I was a software engineer people would always ask me to help them fix their computers. There were so many times where I would say "don't do that" for various reasons. It always amazed me when they would completely ignore me! As if I was just a guy on the corner trying to give them unqualified advice.

    After a few of these cases I learned to let them have their way with the warning that I would not undo what they did to the computer.

    So now, when I go to my doctor I tell them up front that I completely trust them and it's the truth. In the interim, I continue researching and hoping to find something they have not heard of. So far, my current doctor is the only one that has deserved that trust. He will sit with me and discuss options and also email me back and forth. If he tells me not to do something he always gives a reason.

    Unfortunately, he seems to be running out of medications, and in his own words, ideas. He has suggested that I do a bit of research in addition to his. Yes, he included me in the effort. It makes me feel good knowing that he is open to things I might find.

    I'm considering the Nebraska Medical Center for radical surgery. Not sure if I qualify but, look up Dr. Botha and Carcinoid. On youtube you will see a few stage 4 carcinoid victims who are either cancer free or stable. If you cannot find it let me know and I'll send you links. Any how....great post.

    Stay strong ~ Ed

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    1. I don't think Dr. Botha is still at Nebraska but I heard the doctor who replaced him is good as well. You should talk with Ruth Gerdes who had a liver resection there - she is very helpful.

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    2. Oh, I will. Does she have a blog? How would I touch base with her. Wow, you are really on top of this. Feel free to offer any advice you might think of. :-) Any new ideas are always helpful. Thanks for all of your help. :-)

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  2. Good article Beth! Hope you are well..and able to enjoy that early retirement!

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