Monday, April 06, 2009

How to make medical decisions

One of the hardest things patients have to do today is to select amongst the many medical options which the doctor offers to them. Making decisions is always hard work - especially when dealing with your health ! Firstly, this is an area in which you have little expertise or experience . Secondly, the consequences of the wrong decision can be extremely painful, which is why many patients get paralysed into inactivity. This is why patients want a doctor who will make the right decision for them. Unfortunately, it's becoming extremely difficult for doctors to do so, because doctors cannot read a patient's mind - and do not know what their personal preferences are. It was much easier in the past, when patients had a family doctor, who knew a lot about them and whom they trusted completely.

So what's the solution ?

Like most modern doctors, I never tell patients what to do. I believe in non-directive counselling, and believe my role is to help them to make the right decision for themselves.

When they need help, I usually tell patients to follow a three-step technique to help them make the right decision for themselves.

Step 1 - Use your brains

Knowledge is power and information therapy is essential medicine. If your doctor won't provide you with the information you need, please use the internet ; or get a second opinion.

Make a list of all your options. Use the McKinsey system, to make a list which is mutually exclusive and complete exhaustive. Please keep an open mind and just list all your choices. Don't be judgmental or make any attempt to censor the list.

The more the homework you do, the better your results. You can also brainstorm to come up with new options too ( What If I had a million dollars ? is a helpful tool to use when you need to think "out of the box").

Step 2. Listen to your heart

What if you had no constraints ? What would you choose ? Which is your first choice ?( Don't worry about the practicality of your choice right now - this will come later). There should be no ifs and buts at this stage. Continue to keep an open mind and don't think about objections at this stage. Remember, that you need to use a combination of logic and emotions to come to the right decision.

Step 3 Work out the logistics

This is the "nitty-gritty" of the treatment. Which doctor should I choose ? When should I start the treatment ? How can I afford the treatment ?

Patients often try to do this first - and then get stuck. If you do steps 1 and 2 ( in that order), the logistics will usually fall into place on their own. Doctors are experts are organising the minutiae of the medical treatment, so let them do this - after all, this is their job. You need to focus on Steps 1 and 2 - something which no one else can do for you !

You will find this framework extremely helpful in making the right medical decision when confronted with choices. Use it sensibly - and be willing to re-visit it as time goes by and you uncover new options ( Step 1); or your heart's desires change ( Step 2).

And what is the role of the doctor ? I feel my role is to be a safety net, in that I can reassure the patient that I will offer my recommendations ( and the reasons for these); and not let them make a wrong choice - but when there are options, I will allow them to decide for themselves, if they want to do so.

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