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Health science is becoming more effective, but it also carries more risks. This maxim is a real handicap for the bioethicssince, as a general rule in medicine, there is a tendency to ‘do everything until the end’, when sometimes the risk is in doing too much. pose the question of when to stop, however, is not an easy matter. It is also something that, due to fear, shame or ignorance, does not always come out of the patient, who unconsciously assumes the decisions of his doctor.
for the neurosurgeon Christer MjåsetVice President of the Norwegian Medical Association, had always been like this until, one day, he told a patient with a herniated cervical disc that had to be operated on. “Doctor, is it really necessary?she asked.
There, this doctor realized that no, that it was not necessary, that it was the path he had chosen regardless of the patient’s wishes. That was how a series of doubts began to arise, for which he found quite revealing answers.
In his opinion, he realized that society is being “overtreated” with drugs or other treatments that, really, are not essential. “Three out of ten doctors they will prescribe something that is not necessary,” explained the expert in the TED talk on the subject.
However, Mjåset does not blame his colleagues for this problem. He believes that both he and the rest act on the demands of patients and the premise that doing something is always better than doing nothing.
This, by the way, is quite reminiscent of the discussion of the placebo effect and the prescription of medicines with little scientific evidence just for the fact of prescribing something to generate peace of mind in the patient.
For this reason, the neurosurgeon asks the population to internalize four questions and that you always raise them before embarking on any treatment, especially if it is of importance: is it really necessary? What are the risks? Are there other options? What happens if I do nothing?
shared decisions
“This is a TED Talk that I usually put on for my medical students because I think it’s not what every patient should ask, but what every doctor should introduce“, explains Montserrat Esquerda, doctor, psychologist and general director of the Borja Institute of Bioethics of the Ramon Llul University, on the other end of the phone.
Just published your book, Talk about death to live and die better (Encourages), this professional puts on the table a debate that has carried bioethics practically since its foundation, What is the best option for patients?
It is a complicated question, yes, but the truth is that it has an answer and it is Esquerda herself who gives it: “the answer is it depends and it cannot be given by the doctor, with his technical knowledge. It will depend on what the patient values most at that particular moment in his life.”
That is why for her these four questions are so important, because they will help the doctor and the patient to arrive at the shared decision makingwhich should be the previous step to start any treatment.
“Let’s take a small example,” Esquerda illustrates in his book. “A sixty-eight-year-old patient with a advanced stage lung cancer. You have already performed five standard chemotherapy protocols. From that moment, several options can be considered: being referred to care palliatives to address symptoms and prioritize comfort, being referred to another hospital where a trial in this type of cancer or try another drug combination with very little chance of success and many side effects.
What is best for that patient, from the point of view of bioethics, is what he himself considers. Mjåset’s four questions should be put to him and, once all the information has been obtained, he will be able to judge.
“The problem is always going to be that by doing something you assume a risk and that by doing nothing you assume another, but it is that by default we always think that the risk of doing is lower than the risk of not doingwhen it is not like that”, explains Esquerda.
More time
With all the available range of options that medicine now offers, as in the exposed case of lung cancer, decision-making is presented as something much more complex and, therefore, requires that you dedicate yourself to it. more time to stop and think about them. “This is at least what must be done to start talking about treatments, although, obviously, you have to have time to do it, which is another matter”, points out the professional, who leaves the issue of times up in the air frenzy in which health moves today.
However, time should not rule over health and it is important that each patient adequately assess the answers to the four questions that concern us. Plus, it’s something you should always do, not only when it comes to crucial diseases.
Christer Mjåset himself states in his TED talk that in recent years it has been shown that a regular therapy for the knee can have as good results as an operation.
For example, an essay published in The New England Journal of Medicine found that, in the case of knee arthroplasty (surgery to replace a damaged part), known efficiency is 85%. However, it was also concluded that 15% of patients do not improve, in addition to the risks involved in the operation. Meanwhile, 65% found effective improvement with a physiotherapy treatment, diet, insoles and analgesics.
The four rigorous questions would already be answered. Now, what to do with these patients? Well, as Esquerda would say, it depends: “With due knowledge, always it will be the patient himself who decides the best for him.”
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