The idea of “informed consent” has been on my mind for months. In last week’s blog, I mentioned that traditional allopathic doctors often do not give individuals the full information, and therefore the agency, necessary to make well-informed decisions regarding our own health care. We should be able to share the decision-making with our health care provider. Instead, too often we are asked to blindly put our faith in technological monitoring, pharmaceuticals and surgery without real explanations as to the risks and benefits. Doctors act as the gate-keepers for the information, and individuals in the health care system need a way to get to it. Last week, I did not have any suggestions beyond “trust your body’s inner wisdom”. It occurred to me that when dealing with doctors, this might not be enough! We need a way to get the appropriate information out of our doctors so that we are not just giving consent to medical interventions, but rather informed consent when and if we feel the intervention is necessary. My doula trainer, Laura DePasquale, taught us a simple but brilliant acronym to help laboring moms make decisions regarding interventions. She gave us permission to share it, as it is useful for other medical situations in addition to pregnancy and labor. So here is advice from the best doula I know: use the power of your B.R.A.I.N.
B – Benefits: What are the benefits of this surgery/drug? Usually getting this information is not the problem.
R – Risks: There are always risks and/or side effects, and we need to know what those are in order to make a truly informed decision. A perfect example is the corticosteroid cream I mentioned in the last post for eczema – I think if most people knew it could potentially cause hormonal problems, even in an unborn baby, we might opt for a different treatment. If not, at least the decision is truly ours.
A – Alternatives: Are there any other options? Often there are natural options available but the doctor feels pressured to offer the drug/surgery. I hate to sound so cynical, but so often it comes down to money or politics. This is not some left-wing conspiracy theory – we have statistics: the medical industry is big business! Pharmaceutical companies are notorious for funding a new wing of a hospital or providing free equipment or vacation types of trips for “training”, which put the doctors in a very conflicted place when it comes to suggesting their products. In addition, some interventions make the doctor or hospital more money. For example, an epidural typically costs between $2000 and $4000 in Texas. If the doctors don’t suggest an epidural, the anesthesiologist doesn’t make that money. I am not saying that it’s wrong to get an epidural – I am simply saying the doctor “might” have an agenda in suggesting it, and women deserve to know if there are alternatives. True story: In my early twenties, I once wound up in the emergency room with terrible pain in my abdomen. As I had had a prior medical problem in my uterus, the doctor wanted to do an ultrasound. I heard him telling the nurse to start my IV and I interrupted to ask why I needed an IV. He explained that I needed a full bladder in order for him to accurately perform the ultrasound. I asked why I couldn’t just drink water instead. He was clearly annoyed because then he would have to wait longer for my bladder to fill, but I was adamant that I did not want an IV. I had to fight for it, but in the end …. I just drank water instead of getting an IV. Simple, natural, free solution. Many situations will not be as cut and dried as this one, but my point is that sometimes you need to ask if you have alternatives because the doctor will not always suggest them.
I – Intuition: Once we have a good understanding of the benefits, risks and alternatives, our body’s own ancient wisdom will usually give us a little nagging signal to sway us one way or another. However, sometimes we need practice in order to tune into it. (I am still working on this.)
N – Now?: Do we need to make a decision about this right now? Or can we have some time to think about our options before rushing into a decision? Sometimes decisions need to be made immediately and we do not have this luxury but when we do, it’s perfectly OK to ask your doctor to give you some undisturbed time to think about how you would like to proceed. If your doctor is willing, you could also ask for some more discussion time together with your doctor to come to a solution that eases your concerns.
Use the power of your B.R.A.I.N. might sound like common sense, but everyone knows that common sense is not common. Particularly in moments of distress, the most simple solution can evade us and that “common sense” we thought we had goes right out the window. I also personally find that, even armed with the knowledge I have, when I get into a medical facility, I am incredibly intimidated and it becomes harder for me to remember to advocate for myself. I forget that I am ultimately making the choices, NOT my doctor, and I don’t have to agree to everything without an explanation. I am grateful for little tools like Laura’s to help me organize my thoughts, and I wanted to share her wisdom.