But doctor, what are the possibilities?

Biases, decision-making and patient care. Why doctors can’t tell you all the information or unbiased opinions. Ask your doctor for more information.

Each ailment has its own palet of therapeutic options. Often doctors discuss the most medically and culturally accepted option, the one that most patients would choose. However, you might not be like most patients. With time pressure, sometimes not all options are explained well enough and as a consequence patients could make suboptimal choices.

Everyone has their own way of thinking, so information and choices should be tailored per patient. You might think that doctors shouldn’t tailor information, but the reality is that with time pressure not every option can be explained in detail; why should the doctor waste time on explaining irrelevant therapeutic options? Bad choices can be caused by multitude of factors: time pressure, biases and assumptions from the doctor, but also biases and assumptions from the patient.

Interestingly, culture also plays a large role. For example, in some countries, life prolongation is often preferred over quality of life. Louis Theroux made a thought-provoking documentary called “Life on the Edge” (Louis Theroux’s LA Stories episode season 1, episode 2). He illuminated how, for better or worse, the American culture of “fighting till the bitter end” has permeated clinical practice. He showed several situations in which doctors have pushed the life-extending option to the patient. In one case the patient chose to have another cycle of chemotherapy, making him extremely weak in his last days on earth. In the end, the patient died without any life extension benefit. I’m definitely not criticizing American culture nor American doctors, these types of situations can happen in any country and depends on a multitude of factors. One study investigated end-of-life practices in European intensive care units (ICUs). Remarkably, the withdrawal of life-sustaining treatment differed across the doctor’s religion, for example Protestant Christian physicians withdrew life-sustaining treatment in 44% of cases as opposed to 16% of Jewish physicians [1]. Another study surveyed 535 doctors from Sweden, Germany and Russia surrounding end-of-life treatment decisions [2]. They found that Swedish physicians chose fewer life-prolonging interventions as compared with the Russian and the German doctors. The authors concluded:

“The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects both in medical education and clinical practice. The inconsistency in the treatment decisions of doctors from different countries calls for social consensus in this matter.”

Unfortunately, it’s going to be almost impossible to create a “social consensus”, simply because beliefs and ethics varies across different religions, countries and continents. Instead of waiting for this social consensus to happen, I’d want to give you the power to make fully informed decisions. Rather than accepting the doctor’s advice head-on, you may want to consider asking about the pro’s and con’s of each relevant therapeutic option. In short, you may want to ask the doctor: “But doctor, what are the possibilities?”

References

1.         Sprung, C.L., et al., End-of-life practices in European intensive care units: the Ethicus Study. JAMA, 2003. 290(6): p. 790-7.

2.         Richter, J., M. Eisemann, and E. Zgonnikova, Doctors’ authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany. J Med Ethics, 2001. 27(3): p. 186-91.

Photo by Javier Allegue Barros on Unsplash

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