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!
