Who is the one to decide? The patient or the doctor

This is a topic which always come to discussion in between surgeons. Recently in the breast cancer clinic we were explaining to the patient about the treatment options she has. She was a young lady, recently married, mother to an infant. She was detected with breast cancer one month after she stopped lactation. That too, with multiple liver metastasis. She had a lumpectomy in a private hospital. The Fine Needle Aspiration report before lumpectomy was not suggestive of any malignant lesion. But the report of the lumpectomy specimen came out as breast cancer with positive margins. Then she was worked up and found to have metastatic lesions.

            She came to our clinic even without removing the drain tubes of previous lumpectomy surgery. She and her family had lost their faith in the previous treated hospital, once they came to know that the lump turned out to be a cancer. We planned her for further treatment and explained to her the options. Once she was left we had a discussion on what to do, when patients say “Doctor we are ready to undergo whatever treatment you decide”. This is a common reply we receive in our clinics. Most of the patients are illiterate who cannot digest about the various treatment options we offer. But it is not just about illiteracy, educated people too put on the responsibility of taking decision over the doctor.

            Things might be little easier for the physician here. Because most of the time the treatment is not going to do any harm if at all no benefit was received. But with the surgeons it is not like that. Any procedure considered trivial or minor with a calculated low risk can result in an unexpected outcome like death or chronic painful complications. Our junior consultant was of the opinion that if the patient is going to leave the decision to us, it shows their faith in us and it will make our part easy. But according to our senior consultants, they will not embark on a surgical procedure unless and until they hear from the mouth of the patient the choice they made.

            It too early for me to decide. But I always like to follow my dear professors. Experience is something that matters more than brain in surgery!