As physicians, we learn we must inform the patient of their options. Each patient has a different tolerance for risk. Some want aggressive treatment. Some want conservative management. The patient decides what should be done.
I always thought it awkward to merely present a smorgasbord of options and then stare at the patient asking – “So, what do you want to do?” Not infrequently the patient responds, “I’m not sure. You’re the doctor.” The subtext is that the doctor had years of experience with handling such matters. To the patient, this is their first encounter. Surely the doctor could impart his or her wisdom.
“Doc, if you were me, what would YOU do?”
We ask this question of our financial advisors. We ask this question of our lawyers. We do so because we trust their judgment.
Yes, it is true that the doctor is not the patient. And unless the doctor knows the patient well, he will be substituting his judgment for what the patient might REALLY want.
Still, I think it’s a fair question.
And, when I was a patient a few weeks ago, I found myself asking precisely that question.
I was in a bad cycling accident. I had multiple fractures. My proximal ulna was in 4 pieces. It needed surgery. I had a sizeable hematoma in my elbow. And I had road rash from “kissing the pavement.” The medical question was timing of the surgery. Should we wait 10 days to allow the road rash to heal, decreasing the likelihood of infection? Or should I have the surgery within 24 hours to decrease near-term pain and speed up the recovery. The orthopod thought he could make the incision in a “clean area”, a few mm away from the road rash.
I asked “What would you do?”
He replied, “That’s a fair question. I’d get it done sooner. Yes, there’s a risk of infection. But, if you sidestep that risk, you’ll be back to work and activity sooner. There’s no perfect answer.”
He was right, there was no perfect answer. That’s true of most medical choices.
I followed his advice. Had the surgery done the following day. With the benefit of weeks of hindsight, it was the right call. I never experienced any infection.
I appreciated his advice. I was fully prepared to accept the consequences of the decision.
I’m just glad I didn’t have to make the decision alone. Most patients feel the same way.
What do you think?
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