Who Will Decide What is Best for You?
BY ARLENE HARDER, MA, MFT
What should you ask your doctor when making choices on health care and how can you best evaluate the options given?
At one time, not too many years ago, the doctor was an authority you never questioned. Today, because medical decisions are increasingly being made by teams and utilization review boards, many patients no longer have a sense of loyalty to the old family doctor. Further, with an ever-expanding availability of medical information on and off the Internet, patients are less willing to sit back and have their physician make all treatment decisions.
Nevertheless, when you are first diagnosed with a serious illness and struggling to come to terms with what this rude intrusion into your life will mean, you are asked to make some critical decisions, often being told you MUST make a decision right now and absolutely MUST get started on treatment right away.
It can seem as though you aren't even allowed to catch your breath before you have to start treatment — even though later you may learn that the procedure recommended was not the one that you would have chosen had you had more time. So how can you slow down the decision-making process so that you can be as comfortable with your decision as possible?
To begin with, we suggest you remember that whatever you choose in life, whether you are selecting clothes, a college education or health care, your choice depends on what you want, what is available, and what you can afford. The same basic rules apply to choosing treatment for chronic and serious illness. You certainly wouldn't buy a house you didn't particularly like simply because a real estate agent insisted you buy it. You would first draw up a list of your criteria and then would shop around.
Making decisions about treatment you are willing to put your body through is at least as important as selecting a house! So approach the decision-making process for treatment in much the same way you would buy a house. Consider what is important to you and remember that you don't need to be forced into a fast decision. You almost always have time to do at least a little information gathering.
Therefore, in order not to be pushed into making a decision too quickly, even though you don't have all the time in the world, you should know that almost always you have a wider window of opportunity to study your options than it may originally appear.
So take a deep breath (and then another and another) and remember that your life may depend on not allowing yourself to be rushed into a decision. Even with cancer, which can rush people into making fast decisions, you can often take up to two weeks or more to carefully select the doctors with whom you will share decisions that will profoundly affect your life. This will give you time to study the best treatment plan for YOU.
Of course, you have a perfect right to NOT make decisions concerning your treatment — which is a decision in and of itself. For example, some people understand themselves well enough to realize they would "freak out" if they knew all the possible side effects that MIGHT occur, even if the possibility is slight. Others feel they aren't smart enough to choose the treatment and defer to the "experts."
On the other hand, one of the problems with having others make decisions for you is that they may assume that you would be comfortable with the risks of one plan — when you would not — or that you wouldn't be able handle the risks of another — when you would. And so, to help you take another look at your decision not to choose, we invite you at least read the articles in this section and see if there may be something that can help you feel more comfortable in playing a greater role in whichever treatment you will be getting.
In that way, when the day of treatment arrives, you can feel confident that you've done the best job you could in getting the information you needed and that your choice is consistent with your values — even if those values might conflict with the opinions and values of family and friends.
Incidentally, if you've already started a course of treatment and aren't sure it is the one you really want to follow, it is almost never too late to revisit an earlier decision. Just as there is no "magic bullet" guaranteed to work every time for every illness, there is not a straight line from treatment plan A to plan B and then to plans C and D. Along the path of treatment you will need a lot of deep breaths as new choices have to be made when periodic tests point to the need to try a different treatment. Further, since modern medicine allows many serious illnesses that before were guaranteed to be fatal to now simply become chronic conditions, which, while not desirable, are better than the alternative, you'll be coming back to the question of what to do time and again.
© Copyright 1998, Revised 2002, Arlene Harder, MA, MFT |
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