Making Hard Medical Decisions

Back in the glory days of black and white television, Dr. Welby walked into a hospital room, provided a diagnosis, and told his patient what to do. As patients insisted on more of a role in decisions that affect them, often we now find ourselves in the position of our physicians providing options and asking (rather than telling) us what we want to do.


On the one hand, shared decision making is an important part of informed consent. On the other though, many patients find themselves thinking, “I’m not a doctor. How could I know what’s best for me?”


While the answer will be different for every patient, there are two tools often used to facilitate coming to a hard medical decision you can feel good about.


The first is comes from the book by Jerome Groopman and Pamela Hartzband, Your Medical Mind. How to Decide What is Right for You.  They describe 3 scales of how we perceive healthcare.


Here’s the graphic:


Understanding how you feel about these perceptions is vitally important in assessing options that your physician presents to you. Keep in mind though, that where your perceptions are today, may not be where they are tomorrow. It’s OK, for example to find that where you might once have been aligned with a more technological orientation, for a given situation you may find yourself leaning toward a more natural orientation. The key is simply being aware of what feels right to you for the decision you have to make.


The second tool that can help with tough medical decisions is called the Ottawa Personal Decision Guide (OPDG). Developed by the Ottawa Hospital Research Institute in Canada, this tool helps people identify their decision making needs, plan the next steps, track their progress, and share their views about the decision with other people involved with their care.


While not everyone will want to write down their responses to the questions this guide poses, it can be an extremely useful tool to frame a decision based on your values, goals, and expectations. It helps to identify gaps in order to make a decision whether they’re related to knowledge, clarifying values, or identifying support that’s needed to make a decision that works for you.


Studies show that patients that are engaged in decisions about their healthcare are more satisfied with their overall care than patients who simply defer to their doctor. If you were thoughtful in making the best decision for you you could at the time, there’s less chance of experiencing those dreaded “I wish I had….” feelings.


One last thought: If it’s not an emergency, take your time! Even if you sense your doctor wants you to make a decision in the moment, if you’re not comfortable, you can always step back to re-assess, and schedule another appointment when you’re clearer on what else you need to know, as well as the downstream effects of your decision.


Medical decision-making can be daunting, but it doesn’t have to be. An independent patient advocate can help.

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