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Once you have discovered that you have a medical
problem, the resulting tensions and anxieties can
be difficult to cope with. In addition to the emotional
and physical stress, you now find yourselves faced
with making difficult decisions regarding treatment.
The word 'decide' comes from a Latin root meaning
'to cut away from', which essentially means that
decision making by its very nature involves loss;
i.e., giving up one or more treatment options while
grasping another. The very act of not making a decision
maintains the dangerous illusion that you can have
it both ways: that there is no loss, no risk. However,
not making a decision is, in a sense the worst possible
decision of all! Unfortunately, most patients do
not know how to make their own decisions , and expect
their doctor to tell them what to do - they expect
to be spoonfed! A good doctor can and will guide
you conscientiously, and you should trust him sufficiently
to be confident that he will not let you make a
wrong decision. However, the final responsibility
is always yours - you cannot abdicate it to anyone
else!
The decision-making process is different for each patient and depends on individual situations and requirements. Some patients may opt for expensive, high-tech treatment, while others in the same situation may prefer to wait and watch.
The all-important question would be: what kinds of treatment are available? You'll often find that a variety of treatment options exist for instance:
- Medical therapy.
- Surgery.
- Physiotherapy.
- Radiation therapy (for some cancers).
- Waiting and watching (also called "masterful inactivity").
Your doctor will be able to make several recommendations
about treatment. However, there are a number of
important questions that you should always ask your
physician so that you can make the best choice for
yourself. The following questions can help you build
up a reservoir of medical information to assist
you in your decision-making process regarding a
particular treatment:
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- How much will this treatment improve my chances of getting well (In other words, what are the benefits?)
- How much risk is involved in this treatment and what kind of risk is it?
- How long will the treatment take?
- How much will this treatment cost?
- Does undertaking this treatment eliminate other options?
- Are there other options if this treatment fails?
Your physician is the ideal person who can help
you in determining certain vital factors vis-à-vis
your treatment. For example:
- The time required.
- The physical stress or discomfort expected.
- The emotional pressures exerted.
- The risk involved.
- The money required.
Ultimately, it is you who will have to take decisions with respect to the foregoing factors. You will have to ascertain how much money you can spread; how much physical and emotional stress you can bear; and how much risk you are capable of undertaking. On the basis of these decisions, you will need to design your own medical treatment plan custom-made for yourself! Not only will this step help you maintain control over your life as you proceed with the treatment, but it will also help in ensuring that you get good quality medical care.
Nowadays, there are various tools available to help
you make your own decisions. For example, the Foundation
for Informed Medical Decision Making, based in the
USA, has developed 'shared decision-making programs'
on videos and CD-ROMs for common medical problems
(such as breast cancer and hormone replacement therapy)
which enable you to make up your own mind.
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The main factors which
can influence your decision are as follows:
Medical factors:
- Diagnosis (or lack of one).
- Quality and availability of medical care.
- Success rate of treatment.
- Level of technology required.
Personal factors:
- Age.
- Time commitment needed for treatment.
- Feelings - physical and emotional.
- Job and career priorities.
- Financial resources.
- Ethical and religious concerns.
- Family's and friends' reactions.
- Other obligations and commitments.
- Willingness to change lifestyle.
- Aggressive or low-key approach to resolution.
Each of us has a different personal decision-making
style.
It is for you to choose
which one of the following best fits your own personal
style for making medical decisions:
- I prefer to make the final selection of my treatment after seriously considering my doctor's opinion.
- I prefer that my doctor make the final decision with regard to which treatment should be resorted to, after seriously considering my opinion.
- I prefer to make the final selection about which treatment I will receive on my own.
- I prefer to leave all decisions regarding my treatment to my doctor.
It is important to understand that there are no right or wrong styles, and that your style may change as you proceed through diagnosis and treatment. It is imperative that you find a doctor who respects and understands your personal decision-making style.
Just as there are no right or wrong styles, remember that there are no right or wrong decisions about your treatment, and as your options change with time, you may also change your priorities. Try to be as realistic and open-minded as possible. While the final outcome will always remain unknown at the time of making decisions, if you take the time and the trouble to make your own decisions, at least you will have the satisfaction of knowing that you tried your best!
Here is a sample worksheet for making medical decisions about treatment:
Option 1 Option 2 Option 3 Option 4
Benefits
Success
Risks
Costs
Time
Decision (in the rank of choice)
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