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If you are not asking the right questions, are you making the right decisions? Completing these forms is often stressful for patients, requiring self-determination along with self-perception. Who you think you are might differ greatly from the physician’s assessment, adding insult to injury when medical decisions have to be made in the emergency department.physicians

ER Doctor Kevin Haselhorst has provided this information and questions we should be asking our physicians. He is an expert on advance care planning, speaks to patients, family members and healthcare providers about advance directives, palliative care and dying with dignity.

A patient might voice, “I have a high tolerance,” while the physician notes that the patient requires higher doses of pain medication. Some patients with back pain are led to believe that surgery is the only answer while the ER physician might recommend routine stretching and core strengthening. Patients who claim to be fighters of the terminal disease appear to be losing the battle after having to be admitted to the ER repeatedly.

Patients usually prioritize medical evidence over the physician’s assessment. Oftentimes, the medical tests are negative, but this may not necessarily make patients feel better. At the outset of the medical evaluation, did they ask the right questions?? Did self-perception lead patients to be vulnerable or empowered?

Self-perception built upon being well informed empowers patients to have the wisdom to know the difference between good and bad choices during no-win situations. Those who prefer a comprehensive evaluation and better understanding of themselves will ask the following questions even while in the ER:

  1. Is this medical test necessary?

The results from most of the testing performed in the emergency department are normal. This might have been reassuring to the patient, but often unsatisfying overall. Where the patient’s time and medical resources being wasted? If the physician was almost certain that the tests would be normal or that they would not change the treatment plan, was the patient adequately informed? If given the option, patients might wish to have doctors fine-tune their evaluations rather than shot-gun them.

  1. Can you feel my pain?

On a scale of 1-10, how bad is the pain?  Patients are asked this question routinely, but most physicians ascribe to the adage that actions speak louder than a stated number. The gap between the pain that patients feel and what physicians perceive is often contentious and negotiable. It is usually resolved through prescribing pain medication rather than a conversation regarding the alternatives measures of stress reduction.

  1. How am I supposed to cope with stress?

Life is stressful, yet patients and physicians rarely consider tension to be the primary cause of headaches, difficulty breathing, chest pressure or abdominal pain. There is an unspoken agreement that discussions of anxiety label patients as being crazy – suggesting their symptoms are all in the head. Simply coping with anxiety leads to suffering while the end of suffering is ultimately gained through the practice of acceptance – going with the flow of acknowledging and letting go.

  1. How can I be sure you are taking me seriously?

Did the physician take the time to ask a lot of questions? Did the patient know the answers? Surprisingly, patients often have difficulty in describing how they feel or remembering when their symptoms started. The more uncertainty that exists within patients, the less interested physicians become in listening to the patient’s history. Serious conversations can only occur through open-minded participation.

  1. How are my listening skills?

Many patients will claim, “The doctor never told me anything,” while others will diligently ask the physician to re-explain the care plan. Typically, patients are wired to have tests performed immediately and less interested in what the physician has to say upfront. Seemingly, the intention for patients to be understood is more urgent than the need for patients to understand what really makes sense.

  1. What age do you see me physically/mentally?

Very few people wish to look or act their age. Oftentimes, patients prefer to be someone else or ahead of the curve. Health, like age, is a matter of attitude and reason. Hence, the inner child or mature adult might be in charge of a patient’s health. Have you discerned the health issues you can change from the ones you cannot?  Has there been an evolution to the decision-making process through time and wisdom?

  1. Would you ever recommend that I not see you again?

A perplexed 90-year-old patient remarked, “It seems like doctors don’t want anything to do with me.” Did she not count this as a blessing? Would cardiac-bypass surgery be a missed opportunity? Cutting ties with primary physicians or signing out AMA from the emergency department is usually scary. Going out on a limb is a matter of “In God We Trust.”

  1. Do you know how I will die?

People claim, “I have to die of something.” Patients rarely think that they are dying anytime soon – even while treating a terminal illness. Healthcare professionals usually shield or discourage patients from thoughts of dying, yet patients commonly die from heart and lung diseases, strokes, cancer, and infection. Physician, acting as psychics, are generally not ad lib to reveal a patient’s inevitable demise when hope abounds.

  1. Is there an endpoint to the disease process/treatment?

Like any concussion, medical conditions will catch patients off guard. Patients might wonder if the condition is transient or permanent. Medically, the outcomes of a particular concussion are recovery, survivability, and fatality. Personally, the endpoint begins when a patient surrenders – accepting and managing their medical conditions by maximizing the potential to both live and let die.

  1. Do you know me as a spiritual being?

Physicians connect with patients on many personal levels – rarely through a heart-heart conversation. As the end of life draws near, physicians can appreciate the struggles of patients empathetically. This vibe of energy tugs at physicians’ hearts to stop intervening on behalf of the patients’ own good and allow nature to take its course.  Dignity – being the certainty of being right is appreciated in people who are foremost spiritual beings.

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