Field Notes: How to help with a difficult medical decision
Plus, a delightful poem by Clint Smith to add a jolt of joy to your day
Hello, dear friends! Here are this week’s Field Notes, 3 interesting things I’ve run across lately. I hope you find something useful here.
1} Something to ponder:
Why do we get stuck in making a big medical decision?
And how can a doctor, nurse, or family member help?
This incredible post by Dr. Joshua Briscoe shares an important paper about ambivalence by philosopher and bioethicist Bryanna Moore, PhD, and colleagues, which divides ambivalence into 9 different kinds (!!) and offers recommendations for how to help in each case.
Nine different kinds! Basically, why is the decision not coming? Is it because a patient doesn’t have enough information? Or because they are actually not stuck at all, just moving slowly through their own internal decision making process? Or because they do know what they want to do, but there’s an emotional conflict around it? Or because they have given up, and really don’t care to make any decisions anymore?
Dr. Moore’s team has developed a detailed chart of recommendations for each state of decision paralysis, titled “Strategies for addressing ambivalence-related metal states.”
For example, for a patient with “Vacillation-Conflict Avoidance” (maybe the patient wants to do X but thinks the doctors or a family member want them to choose Y), Dr. Moore and her team recommend the care team consider these actions:
“Get everyone out of the room and explore the patient’s preferences.
“Get everyone in the room and name the potential conflict, then explore the patient’s preferences with everyone”
“Combine the above two strategies in a staged approach”
“Normalize the idea that they are no ‘wrong choices’”
I found this level of involvement and care stunning. I’ve never had a doctor or nurse sit with me and help through a difficult decision, much less convene family members to help. How amazing.
Has that happened to you?
Throughout his post, Dr. Briscoe emphasizes how important it is to understand the patient well: “If you offer choices before understanding a patient’s goals and values, you’ve put the cart before the horse. In order to explore someone’s goals and values, you also need a shared understanding of what’s going on. In brief, you move from the news to the goals to the planning. At least then if a patient experiences ambivalence, it’s about real choices oriented around real values.”
This is a long, profound essay around medical decision making, with tons of practical notes. I think it would be useful for patients and for caregivers/friends/families, too.
Read Ambivalence in Clinical Decision-Making by Dr. Joshua Briscoe.
2} Something to do today:
Listen to this poem by Clint Smith. It’s 2 minutes of delight:
Maybe have your own dance party today?
3} Something to remember:
“I do all of growing during the times in my life when I am offering compassion to the parts of myself that have not yet grown.”
— Andrea Gibson
Andrea is a poet, author, performer. She also has cancer. The quote above came from her exquisite post: How Did I Change So Much, So Quickly?
“I learned to love the me who hadn’t changed at all. The me who worshiped worry. The me who made a complaint department of my mind. The me who turned my wounds into microscopes through which I saw the worst in people, especially myself. The me who got it all wrong. The me who was so afraid of death I couldn’t help bury our dog.”
Loving what we don’t love about ourselves is its own kind of freedom.
To our journeys,
Brianne