I’m embarrassed to admit it, but I think I suffer from an addiction. It probably isn’t healthy, and it makes me question my view of reality at times, but still, I cannot stop myself from watching medical TV shows. As a healthcare consumer advocate I am drawn to the show Chicago Med. It offers a view into places where human experience, with all it’s power, uncertainty, emotion, and messiness, is portrayed in Technicolor detail along with bloody surgical procedures. That show really gets my adrenalin pumping! Sometimes the scenarios posed in the show leave me replaying scenes in my head for days. You see, television is a powerful medium that exerts a huge amount of influence. It offers a vision of the world and then leaves us to decide whether the vision is accurate or not. It makes us ask the question, “Is this really who we are, what we do, and what we believe?”
A recent episode of Chicago Med has me pondering some deep questions about the current state of medical care decision-making.
In the show an alcoholic was brought into the emergency room with a broken leg. He was a “frequent flyer;” a regular visitor to the ER, and so one of the nurses was familiar with him as a patient and knew he was an alcoholic. The man began to experience delirium tremens, a painful and potentially deadly symptom of alcohol withdrawal. The man stated clearly that he did not want to stop drinking, and he was not going to take any steps to kick his addiction. He was brought in for an injury, not for getting clean. The patient was having seizures, hallucinations, vomiting, and suffering internal bleeding because of the DTs. All he wanted was a drink, yet the doctor on his case refused to allow him to have one, because the doctor believed that getting the patient sober was what the patient needed. The nurse tried to sneak in a bottle of liquor, but the doctor stopped her and told her, “I’m the doctor. I know what’s right for the patient.”
Who gets to make the final decisions about what the patient “needs?” – the doctor or the patient? What values are wrapped up in the decision-making? This was a juicy scenario to consider for a number of reasons.
First, it raises the question of the ethics of treating a body part or treating the whole patient. Should the doctor have just stabilized the patient enough to treat the broken leg, and not concerned himself with the alcoholism? Does the patient’s assertion that he wants his leg fixed but doesn’t want to be treated for alcohol addiction carry any weight? Does stepping over the threshold of the hospital doors mean the patient must follow hospital protocol, give up his autonomy, and give up his rights to make decisions about his body and the course of his medical care? Medical ethicists and human rights advocates argue that the patient retains those rights, and that doctors are supposed to respect them, even if the patient may suffer or even die as a result of those decisions. In this light, treating only the broken leg and not the alcoholism would have been the appropriate thing to do. It’s understandable the doctor may feel that because he has the training and the resources to treat the whole patient, he should treat the whole patient, but only if the patient consents.
Second, it raises the question of which drugs are acceptable, under which circumstances, and why. The doctor treated the patient with benzodiazepines and with Haldol, which are both prescription medications. He refused to allow the patient to have a medicinal dose of alcohol, even though it’s a substance that anyone over the age of 21 can legally consume without a prescription. Why are the prescription drugs acceptable while the over-the-counter one is not?
Third, how do we judge another person’s capacity to make medical decisions when that person appears to be flawed? In this case, the perceived moral failing of being an alcoholic influenced the doctor’s belief in the patient’s ability to make good life choices. The doctor asserted that his medical authority also gave him the moral authority to override the patient’s authority to make medical decisions for himself.
Lest you be tempted to say, “Michal, it’s just a TV show,” realize that these questions play out in real life every day. As the concept of patient-centered care plays a bigger part in how healthcare is delivered, questions like these, which expose the tensions between patients’ rights and doctors’ responsibilities, cause judgment calls to be made in almost every medical interaction.
Doctors and patients may disagree about what the patient needs to stay healthy or get well. They may have different approaches to health, illness, and questions about quality of life. That’s why things like Do Not Resuscitate orders and living wills came about – so that mechanisms would be in place for patients to express their wishes about how to be treated in circumstances in which they could not speak for themselves. When we are patients, we are dependent upon medical caregivers for their expertise, but we are not required to completely submit to their medical authority. We still retain rights that must be respected. Doctors are human beings who are tasked with using their knowledge and skill to improve the lives of others. Sometimes they use their abilities wisely, and sometimes they make the wrong the choices. There will always be a dance between doctors and patients, and we all need to learn our steps so we don’t trip over each other’s feet.
As a society we make fairly arbitrary rules about things like drug use. The perception is that prescription drugs are safe because doctors prescribe them, yet the over-prescription of narcotics is one of the main causes of epidemic heroin use across the country. Patients become addicted to prescription pain medications, and then switch to using heroin because it is cheaper. And prescription drugs may not be the most appropriate remedy. An over-the-counter product or natural remedy may suffice, but those are unlikely to be used in a hospital setting. When I was in the hospital after giving birth to one of my children, I was told I was not allowed to take the ibuprofen (ADVIL) I had brought from home. There were two main reasons why. First, any medication taken by the patient needs to be noted in the patient’s chart, in case of side effects and to make sure no drug interactions will occur. This is for patient safety. Second, the hospital can charge a premium price for the medications it distributes. They often charge up to $15 for a tablet of Tylenol, which otherwise would cost around 11¢. I was scolded for being a noncompliant patient each time I told the nurse I took the ibuprofen anyway, against their medical advice, so they could mark it in my chart.
Coercive care is a common problem for anyone who is deemed “less worthy.” At a conference I attended recently I heard story after story of patients who were told by medical caregivers something was being done “for their own good,” because they were overweight, a person of color, young, female, transgender, or different from what the mainstream consider to be normal. This is what the Chicago Med episode highlighted; that mainstream medicine does not equal moral authority.
As the practice of medicine continues to change, as it has drastically over the previous few decades, we are challenged with examining the changing nature of the authority and responsibility of both patients and doctors. We need to be mindful of patients’ rights and also be clear about our expectations of doctors and medical care. We need to recognize our biases and morals, and see clearly how they intersect in medical situations.
Watching healthcare scenarios on medical shows like Chicago Med reflects choices back to us and inspires us to compare our beliefs to what we see on TV. Rather than viewing it as straight entertainment, I use the show as a catalyst to examine my own beliefs and to learn more about how these scenarios unfold in real life, for real people. Does that make my compulsion to watch the show an addiction, or a healthy desire? I guess that depends on what the people in the mainstream think.
Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother. Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!