Saturday, April 09, 2005

It's About Time, People

In today's newspaper, a reader wrote in to add his view to the recent discussion about withdrawing treatment or life support in extremely ill patients. He wrote that doctors should not think themselves as God in making this decision. Another reader, an ICU specialist, wrote in, coming from the other side of the coin, explaining that doctors have to communicate with their patients and their families, giving complete and clear information to them in order for them, ESPECIALLY the patient, to make their own decision. He also emphasised the importance of the Advanced Medical Directive as many times, patients who are critically ill & have not signed this directive, are unable to voice their wishes, resulting in much distress to their families & themselves, as well as a huge financial burden.

In response to the first reader's view that doctors think themselves as God, I feel that he has erred in his thinking. Doctors don't think themselves as God; patients think of doctors as Gods and allow them to make the decisions for them. Majority of patients don't question the medical management given to them - they just accept it as "if you say so, it must be OK." It is time that patients empower themselves with the knowledge that is so readily available now, especially with the powerful Internet search engines. They should start researching for information about their own health. It's time to stop being lazy and to stop accepting your doctor's word as the Bible (a good doctor wouldn't mind - in fact, it would help that you understand in some detail what is actually going on).

The second reader is absolutely right about the importance of communication with the patient and his family with regards not only the withdrawal of life support, but also any kind of information that relates to the patient's condition and treatment. Sad to say, the skill of communication is lacking and not addressed in medical school. I say it's time to review the curriculum, and add on a module on "How to Communicate" in medical school - maybe use some of that 200 million dollars that was just donated to the medical faculty to start such a program.

In addition to communication, trained counsellors or psychologists would also be helpful adjuncts to dealing with families whose loved one is terminally/critically ill. Often, the families are trying to deal with their grief and their loss, and one reaction is to try to find someone to blame for "causing" their beloved to die.

Unfortunately, I see many such cases in my line of work, where a combination of poor communication, and the loss of a relative leads to much unhappiness with the medical care given (despite this care having been appropriate).

It's about time for a paradigm shift in the way we practice medicine and in the way we "receive" medicine.

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