The more I thought about my previous post, "Goodwill?", the more I realized that I needed to make the point that I am NOT saying we should do NOTHING. On the contrary, I think there is much to be done. But I think we need to be very wise in our approach.
In fact, this morning my wife and I had a conversation about this topic. As we were talking about "giving" and "helping" in Africa, we started talking about some principles that I use in medicine to guide me (hopefully) in treating patients. I was wondering if they were applicable in our work in Africa. Just because there are risks in helping sick people, as doctors we do not usually withhold treatment just because it "might" cause problems down the road. In fact, as I have worked with medical students I have tried to help them with these priniciples or guidelines.
I am sure there are some gaps here and that I may have extended this analogy beyond its ability to help us in developing plans of outreach, but I don't want us "NOT TO TREAT" or "not be involved" just because there is risk inherent in the work.
Guidelines for Treating People (and Nations)
1. First, "Do No Harm". - Our treatment should not be worse than the disease.
2. Weigh the Risks and Benefits of a treatment plan. Although almost every medicine or treatment can result in a bad outcome, we need to consider the advantages and disadvantages of treating versus not treating. Sometimes you will choose to treat knowing that there are certain risks but that the advantages outweigh the disadvantages.
3. Make Sure You Have the Right Diagnosis. The right treatment plan for the wrong diagnosis can be worse than no treatment at all.
4. Always try to treat the underlying disease, not just the symptoms. Treating a cough with cough medicine is not very helpful if the underlying cause is pneumonia, TB, or cancer. Just because we are "treating the symptoms" does not mean we are doing the right thing.
5. Use Good Evidence Whenever Possible. There are some treatments that are better studied than others. Sometimes the newer medicines are not necessarily better. Not all treatment plans are based on using the best evidence of what actually works.
6. Never Force Medicine Down the Throats of Patients. They won't continue to take the medicine if they don't believe that it will help. They have to "buy in" to the treatment plan.
7. Listen to What the Patient is saying about their problem. They may actually be telling you one thing, but asking for something different. A classic example is the man who "complains" of a cold to the nurse and to the doctor. When the doctor is "finishing up" the interaction and getting to walk out the door, the patient says, "Oh yeah doc. One more thing. Do you think I can get that little blue pill I see them advertising on TV?"
8. Follow Treatment Closely. Sometimes patients may seem to be getting better initially but then get worse. It may be that they are having a side effect to the medicine. Doctors need to consider the discontinuation of treatment if the side effects are too pronounced.
9. Stay Up to Date on Treatment. What used to be the "gold standard" in treatment is now contraindicated or dangerous. Sometimes it goes the other way too (what was not "en vogue" now is). Always be a learner.
10. Positive Outcomes May Occur in SPITE of treatment. Don't always take credit for the good outcome.
11. Sometimes Risky Therapy is the Only Hope. Big problems sometimes require unsafe treatment (ie, cancer). We need to be willing to apply them even though the risk is high.
12. Sometimes Aggressive and Decisive Treatment is Better in Emergencies than Slow, Deliberate, and DELAYED treatment. The trick is to figure out what is an emergency!
13. Almost ALWAYS the Best Outcomes are Delivered with Compassion and Care. Period.
Very thought-provoking! How to apply, now...
Posted by: Keith | March 29, 2005 at 12:26 PM