While I completely support the idea of evidence-based medicine as the foundation for the advice and recommendations given to patients by physicians, most clients I interact with have little to no understanding of what this actually means. Evidence-based medicine is the practice by which the physician finds, assesses, and implements methods of diagnosis and treatment using the best available current research, clinical expertise and the needs and preferences of the patient.
I’ve attended countless appointments with clients where the physician has done an excellent job outlining all the factors for successful outcomes. Even then, what my clients really want to know is, “How does this all apply to me?” They want a customized treatment plan that takes into account every aspect of their lives. Unfortunately, time constraints often don’t support talking through all the implications of the recommendations at the appointment.
At Healthassist, helping clients understand how “all this” applies to them is the goal. I ask my clients to reflect on the conversations they’ve had with their physician, surgeon or care providers. Before long, we’re wandering together in the grey zone, because decision-making about health matters isn’t as black and white as it had seemed.
When considering medical interventions for yourself or a loved one, it’s important to take into account more than evidence-based medicine. Here are some questions to ask:
- What are the likely outcomes if I have this procedure?
- What are the implications if I don’t?
- What are the risks?
- How does this situation affect my ability to perform activities of daily living?
- What other options do I have?
- What resources do I have around me that I can rely on?
- What are the cost implications?
It’s no wonder evidence-based medicine is being heralded as an answer to America’s healthcare woes. Well-researched, proven and documented standards are a terrific place to start. But what about nuance? As the next story in this newsletter illustrates, what’s right for one person may not be right for another.
A Tale of Two Surgeries
Healthassist is all about customizing and the personal. Just as a financial planner helps clients plan for the future, or an education advocate helps parents work with schools to create individual education plans for their children, we work with clients to process information and make healthcare decisions that are squarely in their own best interest.
Take surgery, for example. When someone is of advanced age, it is common to question why one should undergo the risks of surgery. Try discussing this with an 88-year-old woman full of life! This particular client of mine is a spry, socially involved, active woman with a terrific support system. When her knees started to fail her, we talked through her options. What became crystal clear to me was how important her mobility was to her quality of life. Despite her age, she had a low frailty score, an important indicator for positive surgical outcomes.
Because she had family around to help her and a solid understanding of the procedure and the recovery time, we decided together that a knee replacement was a viable option. Her first surgery and rehab went so well, she decided to have a second knee replacement months later. Today she continues her active life.
Compare this experience with that of another client, a 60-year-old woman with a serious, progressive neurological disease. After years of deterioration, she had minimal mobility. Her quality of life was very challenging. A writer by trade, she could barely move her arms to perform her work. She even had trouble swallowing, so the joy of food had become a risk.
It is possible that under the standards of the evidence-based model, this relatively young client might appear “healthy” enough to undergo a surgical procedure, but she’d made an important decision months earlier. She did not want any additional medical or surgical interventions in her lifetime, not even a trip to the hospital. Together we made arrangements for hospice care long before her passing was imminent. In the end, she–who had struggled for so many years–died peacefully at home as she had arranged.
Both of these stories illustrate the importance of nuance. At Healthassist we live in the grey zone every day, helping our clients to understand that they are in charge of their own health. When a client’s wishes are followed, and the outcomes are what they expected, we are reminded how important our work is.