Friday, July 30, 2010

Answer to question # 9: When can a patient reasonably choose care, when are choices reasonably limited and who decides under those circumstances?

Reasonable and desirable choices by patients:

1) Avoid destructive behaviors such as tobacco, alcohol, illegal drugs, severe obesity, reckless driving, use of knives and guns.
2) Learn as much as possible about any present disease/s states and be diligent in caring for oneself.
3) Refuse any or all undesired treatments at any time within the confines of sound mind and of legal age.
4) Find a trusted physician so as to develop a therapeutic relationship, difficult in this age of 10 – 15 minute visits, to help create and sustain a constructive dialog between patient and physician.
5) Realize that the motive of drug and device advertizing directly to the public is to maximize profit and not necessarily maximize patient care.
6) Educate oneself as to realistic expectations from modern medicine and its limitations.
7) Learn about the cost of medical care in the United States, why it is so much higher than in other developed countries and how significantly this affects the standard of living of the middle class.

When are patient choices limited?

1) In obvious end-of-life situations, aggressive care is actually not in the patient’s best interest as it prolongs suffering with no hope of benefit and often causes a more painful and protracted mourning period for the family.
2) In the presence of serious organ dysfunction, depending on the organ/s involved options become progressively limited as dysfunction progresses.
3) In technical situations requiring the acquisition of considerable medical knowledge and judgment the physician is in the best position to define the options and understand the limitations.
4) Patients frequently overestimate the capabilities of modern medicine leading to unrealistic requests for various treatments. In this situation it is the physician’s responsibility to address these unrealistic expectations and not accede to the irrational.

Who should be making these decisions?

1) In most instances the patient along with the physician should decide on a care plan that is both reasonable and beneficial.
2) Physicians and the medical team must not deliver treatments knowing it/they will not be beneficial or superior to a simpler course of action.