The decision is yours, but the doctor is the expert
Questioning the doctor defines modern medical ethics centred around choice. But sometimes, it's important for patients to decide that they will not decide
Do I really need the operation?" Pascal D'Souza, a young computer engineer, asked after I suggested a minimally invasive spine surgery for a sizeable slipped disc in his lower back. It was pinching on his nerves and his condition hadn't improved despite a course of medication and physiotherapy. The pain was shooting down his legs as if he was being "stabbed repeatedly". He could barely sit still, and contorted like a novice gymnast into a posture that led to least discomfort.
"How many such operations have you performed and how many have been successful?" he asked, perhaps condescendingly, as he discretely turned on his iPhone to record the conversation. I don't object to being taped, so he did not perturb me. "What if I get paralysed or lose urinary control? I've Googled the risks of surgery and I'm not willing to do it unless you give me a guarantee in writing."
The chance of him having a complication from surgery was in the range of one per cent to two per cent, I told him. The only guarantee I could give him was that I'd do my 100 per cent.
"I'm going to see if someone else can fix this without surgery," he said, evidently unhappy with my advice as he shook my hand.
Why was I not able to convince him to do the right thing? Was I too young? My receding hairline should have some benefits, I thought. Was I not impressive enough? Not authoritative? Should I have just given him the guarantee he demanded? Do some patients believe that doctors suggest surgery only because it adds to their income? Should I have proposed that he take a second opinion to corroborate my assessment?
It was difficult for me to conclude whether this was his problem or mine.
In the good old days, a physician's advice was considered sacrosanct. Patients were alleviated of their symptoms by simply hearing the doctor's voice or feeling a caring arm gently placed on their shoulder. While some doctors still occupy that position in society, most of us have a doubting Thomas show on at our clinics ever so often, and it's heart-breaking to admit that these are the patients who end up having an untoward occurrence during their stay, if they do decide to get admitted. This will be that one in a hundredth patient who will catch a postoperative infection or remain constipated for five days after surgery, and, when the 'motion' finally arrives, slip and fall in the washroom.
The spiritual world believes in the dictum that the universe gives you what you most strongly desire. Subconsciously, when patients feel that something is going to go wrong, more often than not, it does. On the other hand, there are those who trust in you completely. They are believing and forever filled with gratitude. They accept, after required explanations, and I think they have the best postsurgical outcomes too. I don't expect a patient to blindly trust the doctor but having reasonable faith is what I believe impacts recovery positively. If you accept and believe that your doctor is likely to treat you like he would his own, there is no reason to suppose that you are being misguided.
Of course, I have seen patients for whom I've suggested surgery, get better on their own, as well as those on whom I've operated not do as well as I had expected. These patients are the ones I've learnt the most from.
A few days after I saw Pascal, I got a call from the emergency department. He could not walk and was unable to pass urine. When I examined him, he had developed a weakness in his legs. I told him surgery was the only option and he reluctantly agreed. We operated within a few hours. He regained the strength in his legs but was unfortunately discharged on a urinary catheter. I knew this wasn't going to improve and referred him to a urologist for bladder rehabilitation. I cursed myself for not being able to convince him for surgery earlier. He never followed up with me after that.
A few months later, I was scrolling through my reviews on Google, an act of vanity I indulge in each time I question my role in the universe. I was surprised to find a line left by Pascal: "He was my lord for one day."
I felt a little ashamed.
The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals
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