It’s time we had that talk

You are my patient. Whatever I do serves to make you feel better. Sometimes I can offer you treatments that achieve that straight away. Other times you have to go through painful procedures and treatments with exhausting side effects to increase your chances of feeling better in the future. Whenever that is.

Figuring out what investigations and treatments are indicated for a certain condition is mostly not that difficult. There are certainly disagreements between specialists, but I’m good at finding information and coming up with a solution that makes sense from a medical perspective. It is determining what is right for you that is the great challenge of my work. You are central in this process and I can just guide you through it to the best of my knowledge. When we have time, when we speak the same language, when you are capable of engaging in our conversation; this is the most rewarding part of being a doctor for me.

But when you haven’t been informed about the seriousness of your underlying condition; the tumor that is growing and spreading in your body or the COPD that is gradually choking you, I see no other option but to give you a treatment I would not want for myself. When you fall acutely ill, there is no chance for me to ask about your wishes. I have to save your life so that you can makes those decisions for yourself. Unfortunately the doctors who see you after my initial treatment often miss out on the opportunity to makes sure that the care we are offering is what you want and something that makes you feel better.

More importantly they fail to offer you an alternative. You might very well be given the choice between life and death. I find this strange as we all know that no matter what we do, you are at the end of your life. What I want to know is if you are willing to have us prick your arms until you look like a pin cushion? Should we continue to force tubes down your throat even when you say no? Are you willing to take the risk of drawing your last breath in the CT scanner, forced to lie down when you are struggling to breath?

Some people will undoubtedly say yes to all of those questions. If you are one of them, ask your doctor to write it in your medical records. I will be happy to do my very best to prolong your life by whatever means I have. But if you have doubts, make sure to bring this up with your family and a doctor you trust. Talk through the alternatives. Make sure that everyone involved understands what is important to you. Do you prefer to die from a simple pneumonia in a quiet place? Do you want me to focus all my effort on making you comfortable even if that means the end of your life?

I doesn’t matter to me what you choose. What matters to me is that your voice was heard and that I can hear the echo.