Nancy Finn: How Do Patients Make Good Choices?

Guest blogger Nancy B. Finn is a writer and thought leader on the impact of digital communication on organizational behavior, health care, and patient care.

When you go to the supermarket, it is fairly easy to make good choices about which cereal or fruit to purchase. At the paint store there are a lot of colors to choose from, but you generally can make a decision after a bit of deliberation. When you choose a new automobile, you make an informed decision based on certain preferences such as size, color, style or brand and parameters such as price and performance. This is information that you get from research, reading articles and checking ratings.

When it comes to medical decisions, you used to leave the choice of treatment entirely in the hands of your doctors. Although these decisions are often life-altering, it is now up you or your families to choose which way to treat your medical issues. This change has occurred because for many conditions: (1) There are no clear-cut parameters with proven success; (2) The medical experts differ regarding the best way; and (3) Although there is an abundance of information about medical issues, that information is often difficult to comprehend.

A recent letter to the editor in the New York Times related the story of a patient who was undergoing cancer treatment. The doctor suggested that she have a feeding tube inserted during the treatment. The doctor explained the benefits and the risks but left the decision to the patient. Initially she refused, but over time she realized this was a bad decision and finally after becoming too weak to continue her treatment accepted the tube and completed the treatment. This illustration points out the difficulties we all face when forced to make choices regarding the treatment for health issues.

Let’s take prostate cancer as an example. How does a patient make a choice of treatment among the three approaches, all of which are acceptable by medical authorities, to treat early stage prostate cancer?

Active surveillance – Wait and see what develops with close monitoring by your physician, including frequent blood tests and biopsies.

Surgery – Usually recommended for individuals younger than 70 who are in good health. The strategy is to remove the prostate, realizing that there may be side effects and radiation may follow.

Radiation Therapy – Recommended for men of any age with early stage prostate cancer, particularly for individuals who have health concerns, and therefore who are not good candidates for surgery, and for individuals who have had surgery and need further treatment.

How about the choices patients who have multiple coronary artery blockages have to make? There is the question of whether stents or coronary bypass surgery is the right answer. Although many studies have been done, there is not enough definitive evidence that shows better survival benefit from coronary bypass over stents. Additionally, many patients with coronary artery disease do just as well with medication as with either procedure, both of which are invasive.

Many patients who need a hip replacement do not even realize that there are choices.

These include:

Total hip replacement, where both the thigh bone (femur) and the socket are replaced with synthetic implant materials.

Partial resurfacing, the most bone-conserving approach to hip surgery, where only the femoral head (where the leg joins the hip) is reshaped and resurfaced and the hip socket (acetabulum) is left completely intact. The benefit with resurfacing is that the patient keeps most of his or her own bone, which allows for easier revisions in the future (if one becomes necessary). These differences could mean improved outcome, smaller incisions that heal faster, less blood loss and shorter hospital stays.

Perhaps the most difficult choices are those involving medications. Whether to take medication for certain conditions such as diabetes and hypertension or change your diet and lifestyle are dilemmas that many individuals face. There are also complicated choices to make when deciding with whether or not to do hormone treatment that can have severe side effects.

In all of these situations, weighing the risk/benefit is not easy. What can patients do to help them make these decisions?

Proactively do your research including: reading articles, talking with friends and family, seeking reputable online communities who have similar conditions, and questioning members of the community regarding their experiences so you understand your options.

Engage in a consultative, in-depth discussion with your doctor.

If there is still doubt in your mind seek a second, even a third opinion from other qualified physicians. Once you have all the information you can possibly put together to make an intelligent decision create a chart listing all of the risks, benefits, side effects, and contingencies. If you still have questions, consult your doctor once again because in a trusting partnership with your physician, you should be able to come to the best conclusion for your particular circumstance.

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Comments

2 Responses to “Nancy Finn: How Do Patients Make Good Choices?”

  1. This is a tough yet very important question…it is important to remember (or should I say in my experience) that medicine is a complex integration of many points of contact that include the Dr, the research, the patient, and the problem, the staff reporting the problem.

    Being armed with research doesn’t always result in perfect outcomes. It can make you more empowered, but we also have to remember that empowerment does not equal perfect results either.

    In my experience sometimes even doing all the research does result in perfect outcomes. To the point about hip replacement (something I am very familiar with) …there are procedure options including minimally invasive, posterior approach, tradition, modified traditional, resurfacing..and oh…the part options. There is the stem, cup, lining of the cup, the ball that attaches to the stem. add that with the procedure options results into a multi factorial combination of where things can go wrong.

    But I would far rather be empowered than not….

  2. Oliver Portmann says:

    Very true. I would stress the point you make about asking the patient community what experiences they had. In my mind, nothing beats getting firsthand experiences, because those who’ve actually made the decisions can best tell you how they now feel about them.

    Granted, every person is different, so even learning from others’ past experience doesn’t mean you’ll get the same outcomes. And you shouldn’t try to substitute talking to your doctor with talking to other patients. At the same time you’re better off if you do make use of free services like WhatNext.com to help you form your opinion.

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