If you’ve ever been admitted to the hospital you might
realize what a well-oiled machine it is, and must be to function well.
Depending on what diagnosis is at play, whether that is illness or pregnancy,
there are a series of things that get set in motion the moment someone enters
as a patient. There are protocols, which
say: if this, do that. Most of the interventions and medications ordered are
what people in health care call standard of care, meaning when x is the
diagnosis most people get y.
While this system is in place for the patients’ benefit, to
limit errors and reduce subjective variance for treatments, there are some
negative things that come with this as well.
Many of these automatic triggers for treatment can make a patient feel
they are on a moving walkway, taking them on a path with only one direction.
I often meet patients and families at the end of this path,
by that time frustrated, exhausted, and confused at what all of the treatments
and procedures were for. They shrug
their shoulders resigned to the corralling; vocalizing their discontent with
where they feel the system has taken them.
The truth is, while the system is manufactured to push a
certain direction, there is always a choice.
Patients and families forget that they can step off of the moving walk
at any time. Remember, that our medical
world favors autonomy and gives ultimate consent to the patient.
This does not mean it would be wise to make decisions in
flippant, uninformed, or in haphazard ways.
However, I absolutely advocate for informed discussions on what other
alternatives there are, especially for major interventions.
You should feel empowered to say “I know that most people
are treated with surgery with this diagnosis, but can we talk about what would
happen if we didn’t do surgery” or “They’ve told us our mom will need rehab,
frequent doctor visits, labs drawn, and extensive medication management, could
you tell us how things would look if chose not to go down that path?”
Many assume that if there are alternatives, that these would
have already been discussed or presented.
Let me tell you the medical machine is unfortunately not set up in this
way, the most common plan of action is what gets recommended and carried out.
It takes a bold voice to stop the current and ask “Is there another
option?” Just because no one has
mentioned another choice, doesn’t mean there isn’t one. You always have a choice.
The choice for what is being done is most important as we
near the end of our lives. This is where the path can lead in nearly opposite
directions. With hospice, families have chosen to step off the automatic
disease centered path and start journeying on the patient centered path.
Nothing in hospice is automatic, but instead individual decisions are made,
usually with goals of quality of life as paramount.
The medical system excels at what it is designed to do; fix
and treat disease in an automatic way. The problem is we are more than mere
disease; which is why we should always have the freedom of choice.
