Marcie and I had One Of Those Days a couple of weeks ago. Dr. Vizzini had to go do something neurological halfway through the day, so The Golden Boy took over for him in the afternoon. He gathered his residents like ducklings and re-rounded on all of the patients in the unit.
Marcie had a guy getting ready to go home. He'd had a very minor stroke in a very minor place, and was essentially without any aftereffects. He also had Stage IV cancer of the something-or-other--I don't remember what; I was busy myself--and was on so many anticoagulants it was ridiculous. (Cancer can make a person more prone to blood clots.) The fact that he'd stroked while on an injectable anticoagulant and a couple of oral ones was weird, but not unheard of.
So Mister Man was getting ready to blow that popsicle stand when The Golden Boy decided that he needed umpteen more blood tests, a couple of fairly-invasive scans, another MRI, and some other tests run. To see, you understand, what exactly could be causing him to clot. The answer to which conundrum was "metastatic cancer, DUH," but TGB wanted an exact answer. Like, down to the molecular derangement level.
And Marcie, being the sensible person she is, argued. She pointed out that we had at least a general idea of what the problem was (metastatic cancer, DUH), the patient had a limited amount of time to be futzing around with, and nothing we did at this point was going to make a damn bit of difference. There was, after all, no change we could make to his already-maxed-out medications to lower his risk of stroking again. More tests would mean at least two more days in the hospital, more discomfort, possible complications, and added cost.
Golden Boy argued back that it was incumbent upon him as a doctor to get to the bottom of the problem, and that doing less than that wasn't ethical. He had a couple of other arguments, but by that time, both my hair and my pants were on fire and I wasn't really listening.
Marcie and TGB argued politely back and forth for a few minutes, and then Marcie said something that you never, ever, ever hear somebody in a hospital say:
"Why don't we ask this guy what he wants to do?"
The Golden Boy was taken aback, but he did it. Our patient decided to head home and follow up with his oncologist as an outpatient. And just like that, problem solved.
It's interesting that a doctor would be shocked by another member of the care team wanting a patient's input into what happens to the patient. I mean, we do it all the time for big decisions like end-of-life care, but not as often when we're doing normal everyday stuff. Why not, I wonder? I mean, it's not like being in the hospital automatically robs you of the ability to make good decisions about your own health. It's more like being in the hospital sends you back in time to a more paternalistic day, when Doctor Knew Best (except for when you have a medical directive, and sometimes even then).
It's so simple, really. Ask the patient what they want to do. Just ask.