Dr. Pullen's latest blog entry discusses this frequently asked office question, how it can have several different meanings, and how the answer may change, depending on what the question is really asking.
This article originally appeared online at DrPullen.com, part of the HCPLive network.
Substitute you, Father, Wife, Child, etc for Mother here, and this is a question I am commonly asked in the office. It’s also a question that I answer in different ways depending on the situation.
Sometimes when there seems like a straight forward request for my opinion about the comeptance of a specialist or a treatment option, I simply say something like, “ Dr. X is a really talented orthopedist, and I’d have no qualms at all about having him fix my son’s ACL.” These are the easy ones.
Other times when I feel that this is really a plea for reassurance, or that the patient or family is uncomfortable about something, I’ll use this as a hint that we need to talk more about the emotional aspects of the situation. I might say, “It sounds like you are really anxious about chemotherapy Mrs. X. What is it that you are most concerned about.” Or in another situation, “You seem very anxious about my suggestion that you see a surgeon about having your gall bladder removed. Is there a reason you are especially concerned?” Sometimes the answers surprise me. In the case of the gall bladder surgery, I’ve heard answers that range from, “My Mother died when I was very young of complications from having her gall bladder out.” To, “I hear I can’t eat fatty foods after gallbladder surgery or I’ll have diarrhea.” The issues to address really wouldn’t be helped much by assuring the patient that I’d send my wife for gallbladder surgery if she was in their situation.
Probably the most common time this question is asked is as patients near the end of life, or at least are getting older. The decisions that prompt the question often regard issues about possibly futile treatment, medications to treat dementia or other issues in patients with dementia, or other decisions that have to do with facing death or poor quality of life and the emotional decisions that these force to be addressed. In these cases I tend to say something like. “I pray that I never have to face this type of difficult decisions, but if I do I’ll struggle with the same difficulty you are facing now.” Then I try to help them work through the decision process. Often I can get help from a palliative care consultation when the patient is in the hospital, or from hospice if they are at home.
Other times the situation seems like a straight forward question. “You mean if you had this ugly toenail fungus and had the infection come back after you took the treatment once, you’d just not treat it again.” In these cases I can simply say, “Yes. It stinks that we don’t have better choices. I hope I could adjust to the appearance of my toenails.”
This question is one that I try to not take at face value, but rather figure out what the patient really needs to know. Now I hope I don’t have to face most of these problems in my Mother/Father/Wife/Self because usually I’d struggle with the needed decisions just like my patients have to. I hope I’ll be able to phrase the questions to my family physician in a way that tells him what I’m really concerned about.
Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.