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Doc, What Would YOU Do?

09/16/16 5:00 PM

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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Posted by Medical Justice | in Blog | 8 Comments »
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Joe Schulz DDS
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Joe Schulz DDS

I agree with your thoughts to respond to patient’s request for guidance in areas for which they have little (or no) basis on which to make a decision.
While we have all learned to practice “defensive medicine” who better than us to provide advice within our own specialty?
Obviously this requires a conversation about the pros & cons of reasonable expectations and limitations (AND signed consent) but it seems less than human to throw out the options and be unwilling to offer any guidance.
One man’s opinion…….

Joseph Horton
Guest
Joseph Horton

Until 20 years and 4 days ago, I wouldn’t answer that question when a patient asked me. I specifically dodged it, saying that I didn’t think my opinion there was valid. On Friday September 13th, I had an angioplasty and placement of 4 coronary stents–at age 49 1/2, with no obvious risk factors. There was a discussion beforehand about risks–at least the risks I was concerned about–and they answered the questions to my satisfaction. Within an hour after the procedure, I noticed that my systiolic pressures were decreasing and my diastolics were rising. I diagnosed my own tamponade, which wasn’t… Read more »

Michael M. Rosenblatt,DPM
Guest
Michael M. Rosenblatt,DPM

Dr. Horton, this is a bit off-topic, but I’m delighted that you can still play the recorder. I am equally hopeful that you have made a full return to good health.

If we lived in the same community, or close I would love to accompany you on keyboard with some Bach recorder/flute sonatas. Medical justice can “verify” that I do in fact have the musical skills to do this, although I don’t want to put him on the spot as a music critic.

They are wonderful, beautiful works.

Michael M.Rosenblatt,DPM

Barry
Guest
Barry

I have performed many of these jaw advancement surgeries for OSA. The advantages for living longer with reduced risk of cardiovascular disease is much better than the irritation of the paresthesia. It does fade in time not to be as prominent. There is no visual evidence of the altered sensation. Most people are very happy with the clinical results of the surgery.

NY Surgeon
Guest
NY Surgeon

Interesting blog this week. I face this dilemma every day in my practice as a breast cancer surgeon. “Doctor, if this was your wife, what would you do?”, they ask!! Should I have a lumpectomy, a mastectomy or a bilateral mastectomy? What about reconstruction, yes, no and if yes what kind. Chemotherapy, radiation. What do I do? Well, my wife and I have discussed this scenario many times and in some cases, if appropriate, I will offer up her opinion to those women and their families that ask. Other times I may suggest a different approach, and so forth. The… Read more »

Ari
Guest
Ari

I’m usually asked instead “if this were your parent, what would you do?” I disclose typically that I find it difficult to answer the question faithfully, as I feel that predicting my own response to a similar situation will be imperfect. There are so many variables! Each of us generates his own gut feeling that can be the product of timing, age, health, mood, trust and more. Having this forum here to emphasize the importance of these informed consent procedures is key. These are potentially life-altering scenarios for our patients, and for us as well, and if heaven forbid an… Read more »

D. Shepard
Guest
D. Shepard

As an oncologist, I am frequently asked, “what would you recommend if I were your mother?” My first response is “well, perhaps you should first ask whether I like my mother.” This always gets a laugh, but also reinforces the fact that everyone’s choice situation is different. And outcomes are often different. The patient needs to own her decision in her personal context and not simply adopt someone else’s choice. My next response is to again review the options and likely outcomes, to offer time to think about the decision, and schedule a follow up discussion time. Fortunately, decision making… Read more »

Scott Kasden
Guest

I mainly perform cosmetic surgery, and cosmetic rehab of the massive weight loss patient. Therefore, the procedures that I perform for the most part, are not necessary (occasionally I have a complication). For cosmetic procedures, I respond by going over the pros and cons and encourage them to decide based on their values. I will give answers to subjective answers (e.g., which implant is softer, etc.). For complications and or procedures that need to be done, I take a stronger position. I will explain what is needed to resolve the problem. I will do my duty to explain alternatives and… Read more »