And Coercion

by Joanna Smith on Apr 9, 2014

I was reading an article on atrial fibrillation in Medscape yesterday, and the article ended with a quote from Dr. John Mandrola:

“T he highest-quality care is when the patient chooses the path that best fits their values, preferences, and goals.

And we have made sure the decisions are not a result of ignorance or fear.”

To which I would add:  “….not a result of ignorance or fear or coercion.”

Sometimes clinicians can be very directive, either because that is their style, or because they believe that their patients will make better decisions that way.  For a clinician to say “if it were my family member, I would……” ignores the power of their words and thinking to sway their patients.  It is a gentle sort of coercion.

Better to allow the patient to come to their own decision.  If one of my clients asks me “what would you do if it were your family member?”, I gently tell them that what is most important here is for us to listen to their beliefs about what is best; what I might do for my own family member is not a model for them to follow.  Together we will find the answer that will fit for them.

Deaf? Blind? Across the years, she still speaks

by Joanna Smith on Apr 7, 2014

When I was a young girl, I lived in Easton, Connecticut, a small community of (then) about twelve hundred residents.  One of them was Helen Keller.

When I was seven or eight, I signed up to canvass homes in Easton to collect money for UNICEF, and her home was on my route.

I knocked on the front door and said my earnest speech about collecting for UNICEF. The woman who had answered the door went away and came back shortly with a cash donation and said “this is from Miss Helen Keller”. I asked her to please thank Miss Keller for me, and turned away from the front door.

The landscaping around the home was lovely, with many trees and bushes scattered over the property.  Everywhere I looked there were bird houses and bird feeders of all different shapes and sizes.   I thought to myself, “she must really like birds.”  And then it hit me:  Helen Keller could neither hear nor see. How and why was it that she wanted so many bird houses and feeders at her home?  As a seven year old, I pondered that questions and could find no logical answer.

Today I work as a healthcare advocate with people of all ages and their families—people who are struggling to understand their healthcare needs, make decisions about their treatments and grasp the choices in front of them.  They have many more choices about their healthcare than Miss Keller did.  They are in a totally consuming process that is by nature very self absorbed.  It forces them to look at their lives and priorities and values.  I am privileged to accompany them on these remarkable journeys.

The people I see who manage this journey best are those who continue to stay connected to the world—who put out bird houses and bird feeders—even if they can’t see or hear what those connections actually do.  It is a symbol of the will to be planted here while you can be. And engage in whatever way is possible with life.