Healthcare decisions should be made by an autonomous,
independent person supported by family, friends and trusted advisors, which
should include health professionals. A
person’s health is best driven by decisions that are “owned” by both the
patient and the health professional working collaboratively always reflecting
the values of the patient using the knowledge and experience of the
professional. While the patient is the
final authority, if all those around that patient are merely agreeing with the
person, and “following” them as they make bad decisions, without giving them
the full benefit of their knowledge and experience that results in poor
decision making. Healthcare decision
making should not be driven by an autocratic doctor and should not be patient
self-service. Either end of that
spectrum can result in bad, even catastrophic outcomes.
Two stories illustrate this and both involve potential
stupid decision making by an autonomous, perhaps even intelligent, independent
person. That person is me.
In 2001, I had a right coronary artery angioplasty and stent
placement necessitated by an 80% blockage of that artery. I had some very mild shortness of breath as I
ran through airports, which as a busy
physician healthcare consultant, I did quite a bit. I saw my primary care physician who sent me
over to see a cardiologist and the next day, I was having a stress test with an
echocardiogram to look for any possible problem. The result was clear and striking. My stress test was abnormal and the echo
showed decreased wall motion of the heart in one section with exercise, a sure
sign that there was a coronary artery blockage.
I had an important meeting in another city the next day so I immediately
told the cardiologist that I would have to delay the next step in this process
which was the cardiac catheterization and the resultant therapy depending on
what was found. After all, I was smart
and the symptoms had been going on for a while so why should I change my
schedule for this? I was leading and thought
everyone else should just follow.
Happily I had a cardiologist and a wife who did not accept my leadership
and reminded me that the reality of the situation was that the blockage which
was clearly present could kill me and I would be better off heading for the cardiac
catheterization lab directly rather than fitting it into my work schedule. They chose not to follow my lead but instead
to help me come to a more rational decision.
For those this think this was a momentary aberration in a
lifetime of good decisions, an example from last week is useful. I had to drive a car from Atlanta to
Philadelphia. I like to drive and even a
12 hour drive is something I can do, even on my own, or at least I like to
think so. However I also have herniated
discs and have had back surgery in the past.
My back was giving me some pain at this moment and my primary care
physician had started me on a short course of steroids for the pain. I decided
to drive up anyway. I thought to myself, “I can make the drive. After
all, I have cruise control don’t I?”
That was another potentially stupid decision that could have easily
driven me back to the operating room for more back surgery. The voice of reason was my wife who did not
accept my logic and gently told me (or perhaps not so gently) just how stupid I
was being. Instead my 19 year old son
drove the car up to Philadelphia for me.
I wanted to lead and I wanted those around me to just follow my
directions. Instead they were smart
enough to stop me and protect me from myself.
I tend, like many, to think myself stronger and less at risk
than my 61 year old biology would suggest.
I discount the bad that can happen and focus on the positive. A country song entitled, “I Ain’t As Good As
I Once Was” by Toby Keith has the lyrics, “now my body says you can’t do this
boy but my pride says oh yes you can”.
Those lyrics often reflect just how I feel when I try to evaluate my own
symptoms and my own healthcare options in making decisions. Overall that makes for a happy life however
it may not make for the best health decisions.
I, like just about everyone, need help and perspective and that involves
having people around who you trust and who can lead you as well as follow
you.
Examining feelings and beliefs and helping compare them to
reality is often needed and trusted family and professionals can help do just
that. That often takes repetition and a bit of courage on the part of the
helper. It is easier just to follow and
go along rather than help someone confront the cold hard truth. In my most recent case of personal stupidity,
I asked my son for help after my voice of reality and prospective (in this case
it was spurred by my wife’s voice) reminded me that my back would not let me
drive 12 hours by myself.
In my perfect world of healthcare decision making, both
patient and health professional would have veto power. I want my doctor, nurse, and trusted
advisors, including my Health Assistant to stop me from doing something
stupid. I want them to help me take
action when action is needed. I don’t
want them to passively follow me as I make bad decisions. I want them to help me choose action when
action is needed. I want all decisions
to be mine but I want help, knowledge and perspective to come from those I
trust and from those I love when I make those decisions. I want them to be open and honest and not
just to agree with my bad decisions just to be agreeable. That makes for the best decisions and that
takes time, knowledge and trust. There
are no shortcuts and there are no easy ways around the need to confront reality
rather than just blindly give orders, as some health professionals would like
to do, or blindly follow the lead of the patient as he or she makes bad
choices.
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