Stupid Questions Doctors Ask and “What Matters in the End”

It was 6am in the morning and my 70 year old Dad was just about ready to go into surgery for a major operation (Whipple procedure). The anesthesiologist, who was very nice, came in and asked my Dad if he wanted to have an epidural. The doctor then started to talk about the procedure and the risks and benefits. I could see my Dad was looking like a deer in the headlight and I said to Dad, “You want this.” Dad then agreed but this got me thinking, Dad was in no shape to answer even the simplest question. If the doctor would have asked him what was an epidural? My guess is that at this early hour, at his age and with all the stress and uncertainty he was facing, he could not answer even the most basic question.

Side note: Not that my medical experience was that much better than my Dad’s (he was a medic in the Korean War) but I figured that the anesthesiologist would not be offering an epidural if there was not a benefit and it would minimized pain even if there were risks. I felt at the time, Dad needed reassurance more than he needed a discussion on the risk and benefits of an epidural. I realize by law a doctor needs to ask these questions but I am wondering if there was a better time to ask these types of question.

In the old days, Doctors just did what they “thought best” without even consulting the patient. Today, doctors are trained to provide a range of options and let the patient make the decision. I do not want to go back to these old days and our society, that wants to be in control, would never allow it. But, I do think asking the patient’s opinion is the best only as long the patient understands the range of options presented and can make an informed decision.

From our youth, we are asked stupid questions from parents, teachers and experts like: “Do you want a spanking?” (Side note: if you point out the stupidity of this question to the person asking it, you are much more likely to get!). A good question by an expert will help you better understand and define the problem so you can answer it. A good question is one that is possible to answer or helps you search for the answer. A good question is one that motivates you to find the answer.

I am reading the book by Dr. Atul Gawande, “Being Mortal: Medicine and What Matters in the End” that helps define the problem of our healthcare system and helping to find “What Matters [most] in the End.” A few quotes I especially liked:

“People with serious illness have priorities besides simply prolonging their lives. ... Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The question therefore is not how we can afford this system’s expense. It is how we can build a health care system that will actually help people achieve what’s most important to them at the end of their lives.”

“The job of any doctor, [Dr.] Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world.  Most doctors treat disease and figure that the rest will take care of itself. And if it doesn’t— if a patient is becoming infirm and heading toward a nursing home— well, that isn’t really a medical problem, is it?”

“We want autonomy for ourselves and safety for those we love.” That remains the main problem and paradox for the frail. “Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.”

"The professionals and institutions we turn to should not make it worse. But we have at last entered an era in which an increasing number of them believe their job is not to confine people’s choices, in the name of safety, but to expand them, in the name of living a worthwhile life."

Atul Gawande, “Being Mortal: Medicine and What Matters in the End”

As an engineer who is trained to problem solve, I like the quote ”when faced with a problem you do not understand, do any part of it you do understand, then look at it again.” THE MOON IS A HARSH MISTRESS by Robert A. Heinlein. Problems are solved best when we ask good questions that help define the problem and then we think deeply about the problem, looking at it from different perspectives. Some problems take time to answer. As Albert Einstein has said, “All the fifty years of conscious brooding have brought me no closer to the answer to the question: What are light quanta? Of course today every rascal thinks he knows the answer, but he is deluding himself. Dr. Gawande’s book helps each of us answer the question “What Matters [most] in the End?” but I also think it helps us answer the question: what is the best way to live my life no matter what my health? This is a question that needs “conscious brooding” our entire life.