Shared Decisions
Role Reversal in Care: Good Intentions Get Scary!
Last Friday, our friend, Karen, spent the day with her mother in an Emergency Room and was reminded that, sometimes, best intentions can “go sideways”, even in medicine.
Here’s what happened.
The nurse caring for Karen's mom went over 3 medicines an ER doc had just prescribed. One was a med her mother formerly took, discontinued because it didn’t work well for her. Knowing that patients’ electronic medical records can be out of date, Karen shared this info with the nurse, who responded...
“Oh, so you don't want your mom to get this medicine?"
“No”, Karen answered, “I am just letting you know her history.”
“Ok, I’ll tell her doctor that you don’t want this prescribed for her.”
As Karen shared with me, the nurse's responses gripped her in fear – there was NO way she wanted responsibility for deciding the medications her mother got, especially in the emergency situation she was in.
So… Karen spoke up more directly:
“I am not a doctor. I can’t make that call. I just want mom’s doctors to have all the facts so they can make fully informed decisions treating her today.”
Believe it or not, this type of scenario plays out a lot more often than you may think: medical providers sometimes do a "role reversal", shifting medical decision-making to patients or family members when they show involvement. This practice seems to stem from a good trend in medical care known as “shared decision-making.”
Well intentioned – and based on the sound belief that patients and families are entitled to all facts in their care – shared decision-making is not meant, however, to put the burden of making any final medical decisions on patients/families (most of whom don’t have medical degrees!)
To be fair, we’ve heard many stories of people who’ve over-ridden their doctors' recommendations based on emotion and Google research. That role reversal is concerning, as well.
So... based on our experience as advocates, we offer this thought: try your best to partner with your doctors for best care.
If you’re uncomfortable about anything in your care – or your loved ones’ care – say so. Most providers will appreciate your input! Keep this quick "equation for care" in mind:
Good facts + Good conversations + Good intentions = Good decisions
Next week, we’ll share another scenario that calls for initiating a good conversation with your doctor. In the meantime, if you have tips for speaking up to “partner up” with doctors, we’d love to hear them!