101. Medical Decisions Can Be Hard

You go to your doctor with an illness that may have been present for a day, a week or many weeks. The doctor does some preliminary testing and makes a presumptive diagnosis. The doctor recommends a complicated test or a surgical procedure. How do you decide what to do?

  • A daughter reported that over a four month period, her then 78-year-old father was intermittently confused, had a failing memory and had fallen several times. His doctor diagnosed early dementia but to rule out other causes the doctor had him wear a heart monitor as an outpatient. The monitor showed episodes of severe bradycardia (slow heartbeat) that coincided with his symptoms. A pacemaker was inserted and four years later he is doing well, alert, oriented without evidence of dementia.
  • This elderly man’s quality of life was vastly improved with a simple test and appropriate treatment. When I was in practice and a diagnosis seemed too easy, I always tried to remember to ask myself, “What else could it be?’
  • My neighbor told me about her 94-year-old father who had been falling frequently. After his most recent fall, he was taken to the emergency room because of a laceration of his scalp. After the laceration was sutured, the emergency room doctors said they needed to get a CAT scan. His daughter asked why. The doctor explained that the scan was necessary to see if there’s any bleeding in the brain. The daughter pointed out that at his age and state of health nothing would be done about the bleeding anyway; therefore, there is no reason to get a CAT scan. She credited having read Living Thoughtfully Dying Well with knowing that she had the option of refusing the CAT scan.

The daughter’s simple but astute question prevented an unnecessary procedure. In this country, it is reported that each year 30,000 people die from the complications of unnecessary tests and procedures.

  • An 84-year-old man came to my office because of an inguinal hernia. I verified that he did have a hernia. I asked, “Is it painful, does it bother you?” He replied saying it didn’t bother him at all. I asked him why he wanted the surgery done to repair the hernia. He replied, “I just don’t want to go to heaven with a hernia.” We surgically repaired the hernia.

There was no strong medical reason to do this surgery but psychologically, it gave this man peace of mind as he faced the end of his life and the afterlife.

Making these decisions can be difficult and fraught with anxiety and uncertainty. I suggest two things:1) get the best information you can and then 2) go forward in confidence after making your decision. Knowing what questions to ask is key in getting the necessary information.

Asking questions about a test that’s advised:
a) What specifically do we hope to learn from the test?
b)  How is the test done, and what (if any) are the risks of doing the test?
c)  How accurate is the test?
d) What do we do if the test is positive?
e) What do we do if the test is negative?
f) Does it hurt?
g) Is it covered by my insurance?

Asking questions about an operation or complicated procedure:
a) Why do I need this procedure?
b) How is the procedure done?
c) Is there any way to treat my condition without surgery?
d) What are the risks and complications of this procedure?
e) How long will it take me to recover?
f) Will the procedure preserve or improve my quality of life?
g) How often have you done this procedure?

Making medical decisions can be hard. Good collaboration with your doctor and asking the right questions will help instill confidence in the decision made.

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