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“To Be or Not To Be” – A Problem With Decision Making?

There are two given phenomena of the day. People travel more and people immigrate / relocate more. We are seeing a wider variety of cultural influences and thus a wider variety of medical exposures. We accept that in healthcare the biggest influences on decision-making (DM) is that the standard of care is applied in the best interest of the patient, and that this is supported by four basic principles: beneficence, non-maleficence, autonomy, and just / fairness.

In life, in general, we make decisions every day: What are we going to eat? What clothes are we going to wear or buy? Which movie should we go see? These decisions generally involve one’s personal existence with the objective being to derive personal satisfaction. In healthcare, there is a different objective because the decisions that are being made directly impact the health of someone else. So is there a difference in the path towards DM that is taken between these two broad objectives? Probably the two greatest influences on a specific decision that is made would be 1) your objective, and 2) your personal experience / exposure.

DM in healthcare has become a bit more complicated during the past twenty or so years. With more global travel, more immigration, and more internet, we have more cross-exposure to a greater variety of cultural / societal idiosyncrasies / influences.

Look at what clinicians who are trained in western medicine are becoming exposed to today. Patients who have been treated by practices based on traditional Indian medicine (which might include a variety of philosophies and practices such as ayurveda or unani); traditional Chinese medicine (from which we have already adopted limited use of acupuncture and some herbal medicines); and other tribal or island approaches to healing (from Africa, the Caribbean, and the South Pacific). Indeed, we are seeing established western medical schools starting to offer abbreviated course exposure to elements of these non-western medical practices as post-professional education. Practicing clinicians may take these brief educational exposures in order to either broaden the scope of their practice directly or give them a better understanding of what their patients have been exposed to. Either objective may give them a more eclectic approach to the DM in their individual cases.Look at what clinicians who are trained in western medicine are becoming exposed to today. Patients who have been treated by practices based on traditional Indian medicine (which might include a variety of philosophies and practices such as ayurveda or unani); traditional Chinese medicine (from which we have already adopted limited use of acupuncture and some herbal medicines); and other tribal or island approaches to healing (from Africa, the Caribbean, and the South Pacific). Indeed, we are seeing established western medical schools starting to offer abbreviated course exposure to elements of these non-western medical practices as post-professional education. Practicing clinicians may take these brief educational exposures in order to either broaden the scope of their practice directly or give them a better understanding of what their patients have been exposed to. Either objective may give them a more eclectic approach to the DM in their individual cases.

The principles of beneficence and non-maleficence certainly take top priority when making a decision related to healthcare. The principle of autonomy may be a bit murky from one clinician-patient relationship to another. A wider variety of patient experiences presents a wider variety of patient expectations. Because of such diverse cultural backgrounds as mid-eastern, Asian, African, Islander, etc., the chances are that patients have been exposed to a wide variety of medical practices.

Couple this with an array of DM models that may have influenced clinicians, and one might be able to explain why DM is not as simple as it once was. One DM model is the "divine” model in which religion plays a role along side of the clinician’s medical acumen. Then there is the "conformist” model when the clinician tends to rely on what "most” would do. The "impulse” model of DM would be the clinician relying, to some degree, on "gut level instinct” at that moment of decision. There is that situation in which the clinician might make a decision based on what satisfies the clinician’s ego, referred to as the "egoistic” model of DM. Some clinicians may feel more comfortable relying on the "casuist” model in which they look for analogs. In other words, "How was this done before?” A fairly common approach is when the clinician prefers to rely on gathering data to support his/her decision, sometimes referred to as the "data analysis” mode. Many clinicians are comfortable with a "pragmatic” or "utilitarian” approach when making a decision. They are very similar in philosophy with some subtle deviation such as the pragmatist being concerned with being practical and the utilitarian somewhat more concerned with acceptance / non-acceptance.

Probably most clinicians are or would like to be more "eclectic” in their DM, where they might "mix and match” or tailor make, as they see their case unfold. They may want to feel flexible and judge individually, case by case. This is where the growing diversity of patient healthcare experiences may come into play. Having basic knowledge of the patient’s healthcare experience and making an attempt to integrate this exposure with the clinician’s sense of DM could result in faster, increased credibility, more trust, greater compliance, and a healthier goal orientation on the part of the patient.

Then, perhaps, attempting to solve "To Be Or Not To Be” doesn’t look like such a difficult decision to make.

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