Do no harm: caring for the whole patient
Last week, my dad and I were at his cardiologist’s. I often accompany my elderly but very competent father to his medical appointments. It's helpful to both of us because I can offer my assistance without asking him 500 questions after the appointment. His doctor was going over his recent tests and talking about what the care protocol would be for a man 20 years younger than my dad. At first, I was a little alarmed. Then I realized that he was actually giving an example of the type of care that wasn’t appropriate for someone my dad’s age. I was relieved. “It’s the do no harm theory,” I said. The doctor smiled and replied, “Exactly.” At that point, I knew the physician and I were on the same wavelength.
“Do no harm” is one of the guiding principles of medicine. In Latin, it's "primum non nocere" (first do no harm). It means that the patient’s well-being should be the first consideration when developing a care plan. It's a caution against overtreatment. In other words, sometimes the best thing you can do for a patient is nothing at all.
It’s become very evident to me over the past few years that finding a “good doctor” isn’t just about the medicine. It’s about their perspective too. When you’re 40, interventional care is probably the right – and easy – choice. But when you’re over 85, like my father, the decision isn’t so cut and dry.
My father’s cardiologist isn’t the only provider who understands this. We’re lucky that all his doctors are willing to forgo "gun-slinger medicine" to find the best option for my dad.
But not all elderly patients get appropriate treatment. Overtreatment and undertreatment are both common. A few years ago, one of my father’s doctors wanted to put him through an invasive procedure for what seemed like very little benefit. I went to the pre-treatment appointment to talk it through, and eventually the doctor agreed the procedure could be postponed -- indefinitely. I left the appointment feeling grateful to both my dad and the doctor. To my dad for letting me be involved and to the doctor for listening and being open minded. I was also reminded that medicine is an art as much as a science.
It's important for patients to build a rapport with their doctor. When they are comfortable discussing routine care, it's easier to discuss more complicated matters like advance directives and durable power of attorney. These are all important topics when deciding what care is right for each individual. After all, the “do no harm” theory is a good compass when making decisions, but it can mean different things to different people.