It is not the doctor’s job to make decisions for his patients, but to inform of all possible solutions so that it is his patients who choose theirs.
- The patient is responsible for deciding their treatment
- The importance of being well informed
- What if the doctor has doubts
- What if the doctor wants to impose his vision on the patient
- Recommendations for responsible health self-management
The Hippocratic oath of the doctor says it clearly: the doctor must not apply remedies that could harm the patient, he must respect his decisions and keep secret about what he entrusts to us. This means that medical knowledge is to be put at the service of others, but not to impose it. Before the patient I listen, I observe, I try to understand what is happening to him, I repeat what he has told me and what I have observed so that he understands that we have understood each other.
This dialogue and understanding is part of the diagnosis, which consists not only in putting a strange name to what the patient has told but in reaching both to understand as best as possible the process he is going through. After diagnosis, who makes the decision of the treatment to be followed? It is always the patient who has the last word and I tell you why.
THE PATIENT IS RESPONSIBLE FOR DECIDING THEIR TREATMENT
Once the situation has been raised and understood, everyone must understand their competences, rights and responsibilities. This very old idea has been understood and legalized in the Informed Consent Act.
The patient, once informed, has the right and is responsible for deciding his treatment. And this right goes as far as the competence and conscience of the doctor, who can only help in what is considered competent and when he knows that it will not harm more.
However, the response to treatment sometimes depends on the patient’s body and not on the doctor’s technique. We are not dealing with an exact science but with the application of the best intentions.
The current review of treatments allows us to better understand their effectiveness. On this the doctor will be able to advise the patient, but he will still have to let him choose. That does not oblige him, however, to apply the treatment, because he cannot consciously apply something that he does not consider good or effective for him.
The helplessness felt in the face of pain and illness forces us to be humble in the face of how much remains to be learned and invites compassion and respect, as the Greek doctors did, that doing nothing and waiting for nature to act is a better treatment than intervening causing more damage.
Understanding the healing capacity of the organism itself not only helps to respect non-action, but also to effectively apply the placebo effect (the optimism of healing) before the nocebo (pessimism to cure).
THE IMPORTANCE OF BEING WELL INFORMED
I encourage you to take charge of your own health, be informed and take the risks of each decision.
It would be convenient to go to the doctor’s office with something to take notes, or accompanied by a family member or friend, because four ears hear more than two; and know that you can change doctors or talk to the nurse if you are not comfortable with him.
It is important to ask about all available treatment options or to turn to the Internet and other sources of information if in doubt.
It is also advisable to keep a copy of the medical history or medical reports, and, in short, look for everything possible to improve health.
But we must also be cautious with the excess of information. As Archie Cochrane said, “select all the information and therapies but do not forget the great healing capacity that the body has; Always use it and don’t let anyone destroy or render it useless.”
WHAT IF THE DOCTOR HAS DOUBTS
Sometimes I wonder how a patient lives that their doctor has doubts. And I think he must live it well, if those doubts are explained to him.
In any case, it will be necessary to ask each patient, since each one is different. Surely someone would not want their doctor to have the slightest doubt.
Someone can agree to put themselves in the hands of a surgeon who doubts, while many will say no, but the reality of the surgeon is that, although he almost always practices a well-regulated technique that he knows well, many times he also doubts.
Both the doctor and the patient have doubts, each their own. As a result of these doubts and other failures, new surgical techniques have come to light and others have been perfected.
Sometimes, doctors who doubt and patients who doubt meet doctors and health personnel who have no doubt: they know everything, they learned everything, and that’s why they have their job.
However, his successes can be as limited as his mistakes are unlimited. Many times, they are satisfied to have attacked a symptom of the disease, without understanding what is happening.
Doubt does not imply crossing our arms, it is opening the door to knowledge, to learn together to live and heal ourselves.
WHAT IF THE DOCTOR WANTS TO IMPOSE HIS VISION ON THE PATIENT
The texts of medicine and nursing and the exams of the careers and even the questions of the MIR exams and of oppositions have a perspective and a vision on pregnancy, childbirth and women’s health very different from the current evidence.
When someone has passed a career and competitive examinations and has a public health office, how do you convince him that much of what helped him get where he is no longer useful in medicine and that he is practicing bad medicine?
A big problem is that the know-it-all of medicine is so sure that he wants to impose his truth on the patient and threatens that, if he does not follow his treatments, he will die. But sometimes it is he who with his treatment can harm him, even within the legality of conventional treatment.
The medical system in general is satisfied with its medicine and with its doctors, who do not hesitate even if they are performing bad medicine.
Sickness, suffering and death confront us every day with the fact that little we know about life and death. Although sometimes we help to cure or relieve, there are many questions that arise every day in the head of the patient and the doctor, questions that ask for new answers.
Patient and physician should not see uncertainty as an enemy, but as a friend or opportunity. Once uncertainty is recognized and accepted, more effective solutions can be sought to resolve it.
RECOMMENDATIONS FOR RESPONSIBLE HEALTH SELF-MANAGEMENT
Managing health involves paying attention to four aspects:
- Physical: Getting enough sleep almost daily, aerobic exercise for at least 40 minutes almost every day, and a low-fat, high-fiber diet.
- Emotional: “God, give me patience to accept what I cannot change, courage to change what I can change, and wisdom to understand difference,” Francis of Assisi reportedly said.
- Mental: we enjoy science, curiosity and learning.
- Spiritual: Spirituality is a sense of communion with something greater than oneself. As Elizabeth Kübler-Ross said, “The only thing I know that truly restores health is unconditional love.”
