July 2018 President’s Message

What would you tell Mom?

by Jed Delmore, MD —

What would you tell your mother to do?

Over the past 35 years, the essence of the question has remained the same, though the family member has changed. That is, from 1983 to 2018, the question was how I would advise my mother, then sister or spouse, then daughter, and most recently granddaughter.

As physicians and practitioners, that question is posed to us daily, putting us on the spot about fathers, mothers, brothers, sisters, sons and daughters, you name it. Certainly, some variation of that question is posed to lawyers, financial advisers and other service providers, though usually not involving situations of life and death.

In my view, this question plays to the heart of the physician-patient relationship.

In 1992, Drs. Ezekiel and Linda Manuel categorized four roles physicians play in the physician-patient relationship.

The Paternalistic Approach, in which the physician is the guardian making decisions.

The Informative Model, in which the physician provides factual information regarding treatment options, then implements the patient’s choice. This could be considered the consumer model.

The Interpretive Model, in which the physician explains the patient’s medical status, then interprets the treatment options and implements the chosen intervention. Consider this the adviser model.

The Deliberative Model, in which the physician functions as a teacher or friend enunciating the treatment measures and convinces or advises the patient as to the best option.

Certainly, in varying circumstances and times, I have seen myself in all four categories. The 83-year-old patient being pressured into futile chemotherapy by family members she doesn’t wish to disappoint probably needs a friend and guardian instead.

I suppose most of us would like to say we fit into the Interpretive or Deliberative categories but have been placed in the Informative Model by patients following their extensive Google research. We all adapt to the situation based on a patient’s
medical condition, knowledge base, level of understanding and preservation of autonomy.

Sometimes the decision is hard, and sometimes we don’t agree with the decision, but patient autonomy rules the day.

So, posed with the question of what you would tell your (pick a relative) to do, I respond that just telling any of my relatives what to do would be unrealistic. They are of their own minds. I am happy to make a suggestion, with which they may or may not agree.