In emergencies, patients don’t have the luxury to choose whom to trust, and medical decisions must happen hastily, in minutes even. So part of our job is to build rapport quickly. That becomes harder, impossible even, when we enter into the climax of a medical crisis to find that whatever trust our patient may have once had long ago has been eroded. Many of our patients started their medical journeys wanting to believe in their doctors. But then the medical system that they wanted to trust failed them, in small ways and large, from haphazardly rescheduled appointments to real medical error. How do we begin the process of repair, both as a profession and as individuals, when time is short?
In medicine, we talk about the idea of shared decision-making, in which medical decisions are arrived at jointly by doctor and patient, in contrast to the paternalistic tone of years gone by. As doctors, we do not tell our patients what to do — instead we offer them the information necessary for them to choose the path that is right for them.
For all our training, our medical knowledge is useless if our patients are unwilling or unable to believe what we have to offer. And that isn’t a fault of our patients, no matter how bothered we might become. This is a fault of a system that does not deserve our patients’ blind faith, of a surrounding political milieu that has turned scientific fact into fiction in many people’s minds.
That is how I found myself in that room, early that one morning, with my patient’s wife, her disbelief and the weight of the decision hanging between us. I knew so little about her. I did not know her history or her interactions with the medical system. I did not know the story of her husband’s diagnosis and treatment, or whether he had struggled to find care for his cancer. In our fractured system, I was just meeting her that day. I had no way to make her trust me, except to sit with her, to give her what little time with her husband we could. And to hope that regardless of what came before, she would choose to believe what I was telling her.
I am not certain what she believed, but she chose against intubation. Her husband lived until the rest of his family came anyway. And when he died, they left without a word, carrying with them his bags of belongings and — I can only hope — faith that we had done the best we could.