Sunday, May 19, 2013

Informed Decisions: how advocates can help

Did you ever turn to "Dr Google" for help with a medical decision, only to walk away 30 minutes later, still confused? Ever ask a doctor, "what would you do if it was your wife?"

What are we looking for & how come it's so hard to find?

The science of decision-making has been academically exploding in recent years. Applying those findings to our pursuit of essential wellbeing has proven very interesting and resulted in interesting presentations at conferences like MedicineX and TEDMED.

The physician's strength lies in science. But objectives facts -- and even the experiences of others whom we trust --  are not enough for us to make the best decisions about our care.

I tell patients that there is important knowledge beyond the reach of Google: inside themselves. Without a grasp of one's own psyche, how can we make truly informed choices? 

Values Concordance

We exist in context: our values, preferences and risk tolerance plus social and environmental factors get factored into the very best choices, the ones with what the Informed Medical Decision Foundation calls "Values Concordance," when the care and the patient's values are in harmony.

But what if the patient has no access to her inner life?

Mental illness disturbs our knowledge of self dramatically. A patient with an anxiety disorder will have difficulty accepting risk; a patient with major depression may have difficulty making any decision at all.

Patients with mental illness who have no trusted advocate are vulnerable. The physician with a hammer, seeing her problem as a nail may prescribe and encourage vigorous pounding without taking into account the very serious comorbidity that is impairing the patient's ability to make an informed choice.

Think about white coat syndrome: as you sit in a backless gown in the exam room your blood pressure begins to rise. Do you fear bad news? Is this setting triggering bad memories? Even if you know yourself to be quite rational and of sound mind, your decisions may be affected by your rising anxiety.

Patient empowerment includes agency, certainly, but also appropriate help. I'm proud to provide as much help as I can to patients, no matter what renders them vulnerable at any given moment.


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