Making Choices In Healthcare


Blog post by Joe Babaian

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.

~ William Osler

We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.”

~ Atul Gawande

With these quotes, we know right away that the art of medicine was and continues to be understood by those who take the time to think about the bigger picture! Two greats and many more unnamed, past and present, keep us working to be the best we all can be in healthcare for the right reasons.

Doctor’s orders – sounds simple, and each of us has a conditioned reaction to the phrase. We know it’s a call to listen, follow instructions, trust, to be taken care of. It’s not about dollars or insurance, it’s about the final link in the healthcare chain at the point of personal contact. Care at the N of 1 – but do we follow (blindly or otherwise with true collaboration) these instructions from our clinicians, or do we push back? And if we push back, how can we be sure we are making the best choices?

What role does self-determination play when it comes to seeking expert, professional advice and care? How has the world changed to allow us more measures of meaningful participation in our care?

There are myriad health challenges and diagnoses, plus seemingly at least twice as many courses of action to follow.  When it comes to preventative care such as HPV vaccinations, HIV testing, and even older vaccinations such as for measles, we now find stigma, shame, misinformation, and more impacting wise healthcare choices. How can we educate and mitigate in the face of such conflicting information and pressures?

Today’s chat isn’t about vaccines, but it IS about medical advice/directives and the patient’s right to self-determination.

For example, the point here is easily taken. When the clinician and/or healthcare staff is messaging patients the “Doctor’s Orders,” suggestions, hope, or wish to administer the HPV vaccine for the purpose of preventing cancer, the patient (or their family) is faced with the decision of self-determination. Do we accept that our well-being is being thought of by an expert tradition of healthcare, discuss and receive more detail and education, doubt and ask for proof, decline, or defer? This is the essence of free will. I use the HPV vaccine as an example since the vast majority of the U.S. doesn’t mandate the jab now. So, for now, this is a personal choice.

I won’t give you the answer since there isn’t one. Healthcare decisions, for the most part, are up to the patient. Let’s think a little deeper, put aside bias and soapboxes, and discuss when, how, and where we should or should not be following “Doctor’s Orders” and how the modern milieu has changed our behaviors for good or bad.

Please join me this week as we host the #hcldr tweetchat, dive into personal choice, and consider all the implications. Be part of the conversation on Tuesday, Feb 21st at 8:30pm ET, when we will be discussing:

  • T1 We all want to make the best choices for our own healthcare. In what ways should we accept, evaluate, or reject “Doctor’s Orders”?
  • T2 How does our connected society help or hinder our decision-making for healthcare?
  • T3 What approach should clinicians and staff use when making clear recommendations/directives for our well-being? AKA avoiding paralysis by analysis.
  • T4 Going forward, how will technology help support making the best decisions for our healthcare, and should we again learn to follow “Doctor’s Orders”?

Photo Credit: Photo by Brendan Church on Unsplash / Unsplash grants you an irrevocable, nonexclusive, worldwide copyright license to download, copy, modify, distribute, perform, and use photos from Unsplash for free, including for commercial purposes, without permission from or attributing the photographer or Unsplash.

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