Just because we’re told we need something doesn’t mean we’ll proceed with recommendations. While this may not sound rational there are considerations that, as individuals, we need to make before making a decision.
YOUR TREATMENT – YOUR CHARTER – YOUR DECISION
When we are either diagnosed with a disorder or suspect we may have some medical condition we may respond in one of several ways. This depends on many things and it’s the role of the clinician (in this case the Doctor or Dentist) to approach the subject with his or her patient, in order to support them in their (the patient’s) own decision.
We all know of cases where people choose not to have a blood transfusion because of belief and so it is with other things too. There are however often several reasons to consider and I mention these only as a reference because everyone’s thinking is different, (and that’s the way it should be!)
So the clinician has a responsibility to his or her patient. They have one to their own profession and themselves too. The reasons may not be so obvious however … here are some considerations.
MONEY
Most people would, without thinking, state this as the number one hurdle to treatment – If money alone is an issue however, there are generally ways around the problem if there is a genuine desire to proceed with treatment because of benefits perceived to us individually.
Money is not the single issue alone that its made out to be in healthcare, if it was a choice between your life or your savings what would you choose? Having said that, I have friends who have experienced estimates for medical treatment in seven figures – so it would be misleading to claim that cost is unimportant.
The problem for many is that in most cases the problem may be largely hidden so the drive to consider treatment is minimized. It’s like smoking – “I know its bad generally but it’ll be someone else that dies from it” – we can’t see what its actually doing. In weight loss, “I plan to loose weight” (How many times have I said that! ) yet if we knew the burden on our bodies we may be more inclined, but again there are many factors to consider.
Money is an consideration for everyone, but it’s very unlikely to stop someone from caring for themselves if its within any kind of reach, if you really value and recognise the care recommended and what it will do for you as an individual and for your life.
TIME
Time has become one of our greatest hurdles today. Too much to do, too little time in which to get it done. With the advent of COVID-19 many of the points of contact for care have been shortened or eliminated making treatment easier to access for many.
Time is generally less of a problem than it appears. It’s a perfectly reasonable concern but unlikely (alone) to stop someone from caring for themselves. With all the changes and techniques, post COVID, our time commitment may be becoming relatively small and if you need and/or want a healthcare service it may be easier in some respects to achieve it now, than prior to the outbreak. Certainly however some services have been backed up, but then again some of those can be gotten around now.
PAIN
Many people in the past have feared or at least been apprehensive at the thought of a visit to the dentist. The fear of discomfort or pain has been a consideration in the past although attitudes have changed greatly with the increases in techniques and expectations. The perception of ‘failure’ in ourselves due to us simply not being able to comply consistently is a big one too. Just as big as the fear of many dental appointments, why would you have treatment that you can’t do! CPAP is a perfect example.
So this is a very reasonable question – why would you? Many (if not all of these questions) need discussion and thought. You need to be sure you’re choosing correctly because you always have a choice (even if it is to do nothing and accept the consequences). Its true that many will do what they don’t want to, but with the stresses and expectations in our lives many won’t. COVID-19 again provides an illustration, sadly sometimes in the World’s politicians too!
FEAR
Again, can you actually do what you’re being asked to do, will you do it? Is it going to work? Are you going to look back and see this as something worthwhile? What’s involved? Theses are all fears which many have voiced.
Again, concerns need to be shared and answered honestly without an agenda. As a patient it’s hard to be honest with your concerns sometimes because you feel vulnerable, and lets face it, Dentistry and Medicine are not what they used to be.
Dentistry is a Business and often Medicine is often simply getting you to fit in wth the existing system available. However, if you are to get what you should have and you want, not what someone else thinks you should have – it’s worth the emotional discomfort! When you have the clinician’s opinion, you can either ask the questions that are relevant or choose one way or the other.
CHALLENGING THE RECOMMENDATION
Questioning the doctor? This was something that you just didn’t do in previous generations – now, for right or wrong, people do. Many people are sceptical. Big business seems to control us, our decisions and our money. Medicine is controlled by non-clinicians and accountants and Healthcare administrators take the Lion’s Share of the tax dollars available. So, is this recommended treatment just another example?
Everyone seems to have an agenda or a benefit for themselves these days. They probably always did, but now we have accelerated communication, we see a much bigger picture, although not always”The” bigger picture.
Some say, “I’m not a “conspiracy theorist”, but why shouldn’t I be sceptical and challenge these recommendations?” That’s a good question. Many times you probably should.
When CPAP is so profitable and the number of companies offering these services seem to increase monthly, we’re going to see sales tactics in “Medicine”. These companies have no regulation, but to be quite honest the regulation of Dentists and Doctors is generally by administrative staff at Colleges who have absolutely no idea of what its like to practice in the real world.
Some people won’t have what they need and there’s nothing anyone can do about it. They are just awkward and go against advice, simply because the advice was given. It wasn’t their idea so it can’t be right. Some will soften in time and choose to do something for whatever reason, hopefully not a catastrophic event due to not proceeding in the first place – (although I’ve seen this happen too). Some won’t and “dig their heels in”. Some will wait for even a minor health issue to arise (yet some still won’t do anything.)
We must all accept that they are the ones choosing, and it’s their responsibility alone. In accepting this responsibility, we live our lives. We must of course consider too, the potential medical costs, burden and impact imposed on others by their decisions to not comply. This is the case in many areas of medicine, where its known that there is an increase in probable morbidity and mortality by continuing to do what we’re advised not to. For those that remember it, this was also the case with car safety belts and those who simply refused to wear them.
Accepting treatment. or not, is a right. It becomes more difficult when the society we live in is affected by either our behaviour or our actions. An example is in the known statistic that there is a 7-10 fold increase in car crashes (even small ones) with even a moderate level of obstructive sleep apnea, yet many people don’t accept that the statistic relates to, nor affects them. Maybe it doesn’t, but maybe it affects others in our society?
DISTRUST
“I don’t like or trust the dentist or doctor particularly”, or “they seem to have an agenda”, or “they don’t listen or understand” or are even rude in getting their point across. “Why would I trust someone I don’t much like or respect?”
The answer – GOOD POINT – you shouldn’t. If you don’t like your clinician, then find someone who you do feel comfortable with – your health is not something other people should be playing with. You wouldn’t lend your car to someone you don’t like or trust!
BUT, don’t avoid getting what would benefit you or loose-out because you don’t like or trust someone else’s opinion or attitude, that’s simply not fair on you. You can consider it your right to find someone you can share your journey of health improvement, health maintenance and ultimately happiness with.
Health is not just an absence of disease!
OK, realistically that’s not always so easy. I’ve known people who have been advised to, or advised not to, when it turned out that they really should be avoiding or proceeding. Can you simply change your Physician because they are either not prepared to give you your choices (or they don’t know what they are)? Maybe, maybe not.
With the healthcare system we have (I’m writing this in British Columbia, Canada) we simply don’t have that choice. We’re lucky (and reminded so) that we have a physician at all. COVID-19 may actually have improved this situation slightly though, as waiting lists are becoming longer and even the Government has been forced to find alternatives for Medical consultation and care.
While these telephone consultations are often very valuable, not all alternatives provide a safe option as many of the Services Providers are either not regulated, nor completely non-partisan and certainly practiced without a shred of peer reviewed evidence base. There are also a plethora of ‘alternative practitioners’ that have taken advantage of the public’s dissatisfaction and often downright distrust of the established medical ‘system’ to their own (and often very profitable) benefit.
I have even seen some of the “established professions” tun to this pseudo-medicine for their own short-term financial benefit, completely without question from the Regulators of that profession. It’s buyer beware, but who do you trust?
VALUE
This is the greatest issue and that of greatest benefit to all.
If someone can’t see the benefit, why would they proceed? On the other hand, over the last 40 years of practice, I have seen that with an honest and balanced understanding of the immediate and personal benefit sought, there’s not much that will stop someone from successfully achieving it!
Determining value
Determining value is difficult at times. Whose value are we talking about anyway? Yours or the Doctor’s?
The Clinician involved must provide an honest (to us ) appraisal based on what they know or even to admit that they don’t know. This is not always easy for our professions – sometimes we simply don’t know what (or that) we don’t know. Doctors base decisions on their own beliefs, not yours.
The answer to us is that we have to either trust that someone recommending it, or do some research and ask questions. The answer is often be to do a bit of both!
When appropriate (because not everyone who has a problem needs treatment anyway) this awareness of the value of care to yourself will carry you through just about anything, to get where you want to be.
I believe that those with no value in their own care or the recommended treatment should think twice before committing to anything, and simply to take the time to reflect and if necessary, gather more information – this is for themselves, no one else.
One last point is Consent. It is a patient’s right and a professional requirement (but only by regulated professions) that the patient is provided with their choices. Also the pros and cons of each. This is only a moral issue with non-regulated companies (look at the cosmetics industry!) Alas, Consent is often not provided – which is both unfair to the patient and an issue over which that Doctor or Dentist can penalized Medico-legally. It is a requirement to achieve “Standard of Care.”
I will just end by saying that if you value the management or treatment of an issue that’s bothering you, in other words you want something done because its important to you – there’s not much that will or even can stand in your way in order to successfully achieve it, in our modern and advanced World. It can only be this way when you know what YOU need to know, to make the right choice for yourself.