Being your own best doctor
Many of you know that my final reminder in most of my medical communication is the statement; “Remember, you are your own best doctor”. This is a nudge to take ownership of your health goals while understanding that any professional health care meeting should be a two-way communication on issues and therapies.
This discussion calls into play one of the principle tenants of medical ethics namely that of “Autonomy”. This concept reminds us that we are in charge of deciding on interventions on our person and our children who we are responsible for in their youth. This “shared decision making” should involve an exchange between the care giver and patient on the prime issues on the medical decision and then a joint decision on how to move forward. This balance of power in decision making is at a distinct imbalance though in our common clinic environment. Think of the intimidating scene where patients are sitting on a table, partially covered by a gown, surrounded by “white coats” holding laptops, in the glare of bright florescent lights. This asymmetric scenario is only too common in today’s health care.
As I continue my patient care work in the Telehealth format with CareOncolgy as their US medical director offering the metabolic protocol for adjunctive oncology care, I continue hearing from patients this fear of them advocating for their care path. Many patients voice that their doctor will “drop them” if they question the “Standard of Care” (SOC) option only. Patients frequently have to shop around till they find an oncologist who will modify a protocol, consider alternative options, or actually read data on options, or work together to find the custom treatment that serves the patients unique situation. Increasingly today (as I noticed in the last half of my hospital based career), physicians rightly or wrongly feel “big brother” is watching them and if they diverge from SOC or “guideline” driven care (even with good reason and at patient insistence), they are putting themselves a risk for lawsuits or future ridicule and loss of hospital credentials.
This erosion of shared decision making is quickly eroding at both ends of our life span. Oregon was the first to legalize euthanasia for those rare unique scenarios where there was chronic suffering with no hope of recovery. The “service” is now available in 6 states and has morphed to “drive through” efficiency. The two independent physician review process with lengthily built in shared decision making is now quick, like falling through a “trap door”. Each state has a handful of well-known end of life specialists who work together and “rubber stamp” the cases without the vetting we would want a potentially temporary (or is it temporarily) depressed person really deserves. (JAMA. 2016;316(15):1599. doi:10.1001/jama.2016.14074)