There is this great tool floating around the childbirth education world designed to assist people to make informed decisions about medical interventions during labor. This is empowering because it allows you to feel comfortable and confident in what is happening to your body. I love it because it’s easy and something you can apply to anything in medicine when you are presented with options for how to treat an illness.
I tried to find the original author but was unsuccessful. If anyone knows who wrote this, please let me know. I’d love to give credit!
Every day, decisions are made in medicine. Many people in the international community come from cultures where asking physicians questions and making medical decisions for themselves is not done. The U.S. used to be like that but has moved to a more patient-centered model of care where the patient is expected to speak up and make informed decisions, but sometimes that is difficult for everyone. It can feel intimidating to ask questions or disagree with someone who has so much education and experience.
Some people take the opposite tactic and instead of meek and afraid, they become combative and are afraid that medical professionals are out to hurt them or make as much money as possible. While there are bad actors in medicine, most medical professionals are caring, ethical people who want the best for their patients. This tool can help facilitate polite communication that is assertive instead of passive or aggressive. If your physician is not willing to have this conversation, then you may assume perhaps your best interests are not at the forefront of the conversation and it might be best to find a new one.
Use this tool to help you slow down, think through a decision, and make the one that is right for you and your situation. It is not about distrusting medical professionals, but about asking the right questions to figure out what is right for you. It is your body and you should feel that you have a say in what is happening to you. Whether you are in labor or are facing a cancer diagnosis or are told you need surgery, ask questions and feel confident in your decision.
B: Benefits
What are the benefits to the treatment being offered?
R: Risks
Nothing is without risk. What are the risks? Risks might be physical such as side effects, or they may be financial, such as in the case of an expensive experimental treatment insurance might not cover.
A: Alternatives:
What are the alternatives? Is there something cheaper we can try? Something different but just as effective? There is almost more than one way to treat something. You can also ask about the benefits and risks of these alternatives.
I: Intuition
Once you have all the information, what does your intuition say? What do you want? What do you think is best for you?
N: Nothing
What happens if you do nothing at all or delay the start of treatment? Do you have more time to think it through if necessary?
Many doctors will go through the benefits and risks of your treatment options when you first present to them, however, some have favorite treatment methods and may present only one. Let’s run through a scenario to demonstrate how this might look.
Example: Mrs. Gonzalez
Mrs. Gonzalez is a 67-year-old woman who goes to see Dr. Haddad for knee pain. Dr. Haddad takes some x-rays and tells her she has degenerative osteoarthritis and needs a knee replacement. Mrs. Gonzalez is worried about the expense and recovery time of a knee replacement. She goes through the tool with Dr. Haddad
Benefits: Benefits of surgery include reduced knee pain and increased mobility.
Risks: Risks include infection, the failure or rejection of the hardware, and other complications associated with the surgery itself such as blood clots and pain. There is also a small chance it will not heal correctly and Mrs. Gonzalez will continue to be in pain.
Alternatives: Alternatives include physical therapy, steroid injections, or oral pain medications
Intuition: Mrs. Gonzalez is worried about surgery. She thinks she can comply with more conservative treatments first to see if they work and then do surgery if the more conservative treatments fail.
Nothing: If she does nothing, her knee will continue to deteriorate, limiting mobility.
Ultimately, Mrs. Gonzalez decided to do a steroid injection to take care of the immediate pain and do physical therapy to help strengthen the muscles around her knee to see if that could help keep the pain away. She complied with her physical therapy and while her knee was never completely pain-free, she found the discomfort tolerable enough to go about her daily life. She felt confident in her decision.
There are a few situations where you may not have time to run through this. Those situations do not describe the majority of needed decisions, however, so use this tool when it is safe to do so. Practice using it at home before a doctor’s appointment or hospitalization so you are familiar with it. You can even click here to print out a FREE template as a guide to bring with you to your appointments.