Whether you are a physician or other clinician on a healthcare team, these four criteria can help you and your patient make the best choice.
It’s August 3rd, 2024. Today would have been my father’s 95th birthday. And all I can think of is eating crabs! I remember my Dad bringing them home from the docks of Sheepshead Bay in the summertime, on his way back from rounds at the hospital in Bay Ridge, Brooklyn to our house on Long Island. I often wondered how they survived the ride in the trunk of his Oldsmobile Toronado along the Belt Parkway and Sunrise Highway to our house in Wantagh. But there they were, being poured out of the heavy paper sack into our kitchen sink. I would stare in awe at them as they crawled over each other, finding their sudden, though temporary freedom.
My father warned me not to give them names, because that would make it harder to eat them later. My first lesson that we become attached to the things we name. He also warned to be careful of their claws, strong and open, not banded like the occasional live lobsters we’d have as a summer treat when we could afford them.
…if we understood anatomy and how to take things apart, we could find the sweet and tender parts that would feed us.
He taught us not to be afraid of them, even after they were cooked and their shells had turned red and angry in my mother’s boiling cauldrons (He always made her the bad guy.) That if we understood anatomy and how to take things apart, we could find the sweet and tender parts that would feed us.
He never forced us to eat them. (There were always hot dogs and hamburgers to complete these summer weekend feasts.) My younger sister, at times insisting on assigning names to some, would never be subject to eating crabs if she didn’t want to, but watched the anatomy lessons and ultimately became a skilled shellfish gourmand. We always understood that we had a choice.
At every decision point, I came to learn (from both my parents, really) that there were choices to be made, uncertainty to be appreciated and risks to be mitigated. Male or female, still living or perished, how big a pot, how much water, how many bay leaves and other spices, how to transfer to the pot safely, are they ready yet, are we ready yet, do we have the right tools – mallets, nutcrackers, tiny forks, how to clarify the butter, when to put on the rice? All of these judgements made with some degree of imprecision, no absolute right answer (but don’t tell that to my Mom).
And so, I learned, in this delicious way, the fundamental criteria for sound surgical decision-making, how to share the relevant information for informed consent, and how to assess (with some degree of imprecision) a patient’s capacity to enter a shared decision-making process when faced with a medical decision. These are
- Expression and communication of a choice, or decision that needs to be made.
- Understanding of the relevant information needed to make the decision.
- Appreciation of the consequences particular to each patient and situation.
- Reasoning behind the choices and ultimate decision.
I am so grateful to my parents for teaching me and my siblings these important lessons so early in our lives, and for the opportunity to share them with you, today. Whether you’re a surgeon or other clinician on a health care team or a patient or health care agent struggling with an important health care decision, these criteria can help make sure all the elements are there to come to a solid decision.
What is your comfort level with medical decision-making? Can you identify those close to you who seem to excel in these four competencies? They might be the best folks to have with you at your next doctor’s visit, or may be just the right person to appoint as your health care agent on your healthcare proxy form or other advanced directive.
Let me know in the Comments, below, how you’ve used this information. I’d love to hear how it helps. Also, if anyone knows where I can get some live, Maryland Blue Claws…