My most important job is to help my patients (and their families) who are depressed, grieving, or angry following severe injury or illness to imagine possible narratives for the next chapter of life.
AMA J Ethics. 2015;17(6):500-505. doi:
10.1001/journalofethics.2015.17.6.ecas1-1506.
Dr Jonathan Treem joins Ethics Talk to discuss his article, coauthored with Drs Joel Yager and Jennifer L. Gaudiani: “A Life-Affirming Palliative Care Model for Severe and Enduring Anorexia Nervosa.”
The physician must help patients understand that all options—further testing, surgery, no action—carry risks and benefits. Disclosing the statistical probability of injury and other possible outcomes might help, but it can also hinder the process.
After assessing the reasons for a patient’s unrealistic hopefulness in the face of clear understanding, a clinician may believe that significant harm will come to the patient if he or she does not acknowledge the seriousness of the illness.
Requirements for informed consent are relatively vague and the exceptions are few, so it is in the physician’s best interest to inform patients about proposed treatment options, ascertain that they understand their choices, and secure their consent.
Fibromyalgia, with no positive tests, is a “foreigner” in the medical landscape. Medicine looks for signs of pathology, changes in the structure or function of organs. The mantra of physicians facing patients with fibromyalgia: “Your tests are normal.”