Making decisions about medical care can be a daunting proposition – we know this from our own experiences. Start with the sophistication of diagnoses, add the complexity of medical procedures, and top it off with a menu of treatment options. Deciding what to do can be a recipe for anxiety, paralysis and/or self-doubt – even among those who are highly informed.
A new book takes on the task of helping people make the medical choices that are right for them. Your Medical Mind, by Drs. Jerome Groopman and Pamela Hartzband, begins with a fundamental assumption: there is often more than one correct decision for patients. It then tackles how patients can go about determining what care they want. In addition to coaching readers to gather the factual information about their options, the authors help people understand how their personal values – their goals, dislikes, and fears – can inform what medical decision is best for them.
Your Medical Mind helps people understand how they view medicine and medical treatment, whether as doubters (who tend to worry about the side effects or risks of treatment) or believers (who are convinced that the treatments or approaches will work and prefer to “do something”) or as a blend between these two extremes. They also suggest that patients look at the effect that the options will have on their lives and why these either matter or don’t matter to them.
Understanding and recognizing this can help patients make choices they are more comfortable with, and it can help doctors guide these patients to choices that are better suited for their beliefs and values. For instance, one patient didn’t want surgical thyroid removal for Grave’s disease because he didn’t want to be forced to take a pill every day.
Another preferred the surgery because he wanted to “just get it over with” and move on with his life.
The significance of this book’s approach to decision-making is amplified when clients are faced with serious or end-of-life decisions about care. This is exactly the role that advance directives try to play. And it is also, I would argue, exactly the kind of conversation that’s particularly important for patients and health care surrogates to have. It is important for clients’ health care agent(s) to know, fundamentally, what the clients’ goals are when facing an end-of-life or other serious condition. And this includes even going that next step further – WHY is that the goal? Or WHAT does the person like or not like about that option? This will help clients communicate to their agent what’s really important to them. Is the goal to live without pain? To be able to tell jokes and watch Sunday afternoon football regardless of one’s physical abilities or limitations? To be able to take a Sunday afternoon stroll, even if one’s memory is lacking?
This book, and others like it that attempt to help clients dig below the surface level of their decision-making, may be useful tools for clients and their loved ones. It may be especially helpful to clients and their agents in talking about some of the big end-of-life treatment questions. Having additional language and another way to frame the conversation can only help.
Please let me know if you recommend any tools or resources that help clients and their surrogates improve their communication, complete more informed advance directives, or make better medical decisions. I am interested in learning from your experiences.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directive registry in the U.S., which ensures that the healthcare directives of its 190,000 enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
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