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Posted Sep 26 2012 11:39am
Sorry I missed posting on Monday - I've got a new work routine and it's throwing a wrench in my "usual and customary" schedule. Today's musing is all about the problem of minimizing. Psychologists and behavioral therapists know that the process of minimization is one of a set of disordered thought patterns that humans get into. Minimizations are those thoughts that do what the name implies - it takes a situation and falsely reduces the impact of it on others. One of the problems in healthcare, especially with physicians, is the common practice of minimizing the impact of procedures on the lives of those they are acting on. Case-in-point, I've had two conversations in the last week with folks about the benefit/burden of surgical procedures on loved ones who are nearing the end of their lives. In both cases, physicians have told the families that a given procedure is straight forward and easy to perform. In both cases, they are absolutely correct - the act of the procedure in both cases is quite easy for an experienced physician to accomplish. However, the burden of living with the procedure is never discussed. This is one of my main problems with the way that our healthcare system currently operates. There is no real informed consent - decision makers are only given one side of the story and are expected/led to make a decision without full disclosure of the likely long-term issues. Couple this with the fact that in both cases the patient in question had done no end-of-life planning or advanced directives and the situation quickly becomes a nightmare for an already stressed out family unit. The mantra of Medicine "first do no harm" has been co-opted into don't harm the patient with an intervention, but don't tell them the real burden of living with the intervention. For example, one of the people needed a tracheostomy to facilitate mechanical ventilation. This is an "easy" surgical procedure, but the burden is then living with long-term mechanical ventilation in a skilled nursing facility probably bedridden for the rest of the person's life - at significant societal and family cost. The alternative is no procedure, extubation without reintubation, being kept comfortable and pain free as the person breathes their last surrounded by family and friends. Which would you choose for yourself or a loved one? I urge all of you to make and Advanced Directive and Medical Power of Attorney soon. Discuss your wishes and make clear what you feel is important to being alive. If you don't the medical minimizers might just come calling. Peace for the journey, Dan

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