Friday, August 15, 2008
Parradox
(two MDs consulting on a case) I wish everything in medicine was cut and dried like it is on TV. Sometimes though, you have to scratch your head and take a SWAG. (scientific wild ass guess). To help figure it out you call on partners, collegues and whoever you can get. The problem usually is that they are guessing too. It is one thing to sit back and guess from the sidelines, but having to act on the guess is a totally different thing because it is not you who will pay the price if you are wrong. Just recently we had a case where there is really not a good answer that has been determined for what to do with this type of cancer. My partner and I each had different opinions, two docs with a paradox. We tried to explain the diffent options and then the patient looked at me and said, do what you think is best. Luckily, they did well.
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There are many admirable fields of work to be in and they all serve their purpose, but being a physician has the responsibility of making tough decisions, carrying through actions that can mean life or death, disability vs restored back to good health. Is there any more sacred responsibility, other than I suppose clergy who helps direct one's soul from this life to the next? And while I suppose there is the deathbed urgency of reaching someone's spirit, they usually have time. With physicians you have to do your best to make that correct call. It must be intense in the OR sometimes when things aren't going well, and literally your patient's life is in your hands. It must feel awful if you lose someone on the table even if it isn't your fault. To that I say and really believe... it WAS their time... and the means God used to bring them home. I know..I've digressed..just caught up in the awesomeness of responsibility physicians, particularly surgeons have.
All doctors do and they hopefully are good at diagnosing and then referring out when appropriate. the PCP's can miss things and patients can end up concerns they shouldn't have to have.
I would formulate my own opinions first from every possible angle, trying to determine every projected outcome, see if there is a pattern and if they all point to one thing.
Then I go to various trusted sources and take their ideas, why, etc. Measure it up against mine and again see if it points in the same direction. In the end i guess it comes down to more pros vs cons, but as you said...if you are wrong...it is the patient that has to live with it.
The power you hold through your knowledge and skills... it must be rewarding beyond description when difficult cases go well and are successful and it must be heart wrenching when you lose a patient you have valiantly tried to help/save. And then all the cases in the middle... you really have an awesome job and sometimes you must feel like you have the weight of the world on you.
I accidentally hit publish instead of preview but I guess I will leave it.
Your post very much ties in with what i am feeling/wondering right now in reference to my own case and I am wondering if my doctor is perplexed.
I am not sure of what my outcome was the other day but I believe my ureter is still wanting to close, even though I had this big stent for 7 weeks and had a smaller one for 2 weeks prior to that. He did things differently post-op than he ever did before and I am concerned that maybe I didn't heal like he had hoped. We haven't had a face to face discussion yet and now he is away.
He has recommended surgery in the past... but because I am high risk, and my knowing I am "not a good candidate for open surgery", I have this major wall of resistance to doing it where I never have before, but then again...I never had anything as serious. And barring the fact that there are inherent risks to all surgeries, the outcomes of past surgeries were predictable with minimal risks.
But with this...it isn't so black and white and I imagine my doc has wrestled with my case. I know he has worked hard, has listened to my concerns, knows my heart about it and is trying to accommodate my wishes...but I can't help but wonder if the writing is on the wall after this last OR trip. I am praying he will still give me the option he originally presented to me at the beginning of the summer.
You said "We tried to explain the diffent options and then the patient looked at me and said, do what you think is best. Luckily, they did well."
I trust my doctor implicitly and more than any doctor I have ever had. he probably doesn't think I do.. because of my resistance.. but I do. If I do the surgery he is referring me out and everything in me wants him doing it but it is a different hospital, etc. and while I like and trust the consulting surgeon who did agree and was confident about taking on my case, which helped me to see his attitude... he is not my doctor. I guess that seems silly when people travel around the world to see strangers that will help them and I am only going to the next county.
I as the patient am having to live with this over my head if it is not healing. I want to run away from it but my ureter will still be with me and that isn't any option he has offered to date. ;)
A couple of years ago he told me he didn't want to see me put my life on hold and that is EXACTLY what I have done...EXACTLY!
But I don't want to go through a high risk surgery if I don't have to. I'd rather be stented but how often can I do that? I feel like I am between a rock and a hard place and I guess he is too. We both are.
I so much want to use this year to get healthier so that maybe I won't be considered as high risk. I as the patient am not saying never...but just want more time.
In the end though...all you can do is your best. You are not God. you can't know for certain what the patient outcome will be... but you can also offer them hope they wouldn't otherwise have.
SWAG! LOL!!! Very funny. Hmmm...maybe next time I see my urodoc I will ask him about his SWAG. Thanks for the laugh! :)
And for the thought provoking post. This one as you can see hit close to home. :)
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