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Making Informed Medical Decisions

By Chan Lishan, Mental Health Advocate

I remember when I was diagnosed with schizophrenia in 2008. I was subjected to a series of trials of different medications, all which had terrible side-effects. One gave me blurred vision, another gave me nausea. In the end, the medication deemed best and most suitable for me left me with a heavy head and very stiff shoulders that made me walk like a robot.

Later on, in seeking a second medical opinion, I tried a medication that not only significantly lessened my symptoms, but also did not have such challenging side-effects. But when my caregivers questioned the original prescription, they were told that this medication had not been considered because it was very costly. 

This made me realise how important it is for the patient and the patient’s caregivers to take an active role in informing the psychiatrist of their particular and personal situation, and of asking questions to make sure that the medical recommendations made by the psychiatrist are justified. In this case, I could have avoided many months of unnecessary struggle had I asked, early on, if there were alternatives to his recommendation.

Improving patient-doctor interactions

Currently, we see the doctors or psychiatrists as the experts who recommend solutions to the patients. As such, the bulk of responsibility lies on the shoulders of the doctors, while the patients are the obedient and unquestioning receivers.

But because of the conventional trial-and-error method of prescribing medication, the patient may be spending time and money, taking unsuitable medication for months on end. Wrong medication can cause unbearable side-effects, which may lead patients to refuse medication altogether.

Medication

At the same time, the patient and the patient’s caregivers may have the best understanding of the symptoms and events that led to the illness, as well as intimate knowledge of what might be the most suitable or appropriate for their particular situation. This knowledge may not be adequately tapped on in the current doctor-patient relationship model.

I would, therefore, encourage patients and their caregivers to play a more active part in the recovery process, by seeking more information and asking more questions and providing feedback in their sessions with the doctors or psychiatrists.

Is this a realistic aim?

Some might argue that patients are typically not well enough to be able to assess their treatment options. Typically, they might be confused and unclear about what they want, especially if they are in the throes of hallucination or delusion. They might not even realise that they are ill and in need of treatment.

In these serious cases, the role of the caregiver in helping to evaluate the treatment options becomes paramount. In some cases, the caregiver’s involvement may yield better results, since the caregivers are people whom the patient knows they can trust. Yet, caregivers may not be sufficiently informed to be able to take on this role.

It may be the case that patients are paranoid and suspicious of the doctor, and even of their caregivers. In these cases, the patients cannot be forced, but must be slowly and gently persuaded that treatment is to help and not to harm them.

However, for the patient who has gained clarity on his situation and who is seeking help, or for the caregiver who wants the best for his or her loved one, it is definitely a good thing to be more actively involved in the process of evaluating options and of directing the recovery process.

So, how do we go about making a more informed medical decision? Here are some possible questions the patient or caregiver might want to consider asking:

Questions to ask the psychiatrist

  • What is the diagnosis and what are the symptoms that led to this diagnosis?
  • What are the treatment options available to me?
  • What are the long term and short term side-effects of each medication?
  • What are the chances that I will experience these side-effects?
  • What is the cost of each medication?
  • Are there any brochures or further information on websites that may be useful to me? Which websites would you recommend?

In the case where the doctor has recommended a particular treatment:

  • Why did you recommend this particular medication?
  • Is this the most successful treatment available?
  • How long will I be on this medication?
  • Is this the lowest effective dosage?
  • How will I know if the medication or treatment is working or not working?
  • Is a non-drug treatment, such as counselling or therapy, a good alternative?
  • Who should I contact in an emergency?

Questions to ask yourself

  • Do I feel comfortable with this doctor or psychiatrist?
  • Which treatment option(s) is/are the most appropriate, given my aspirations and expectations of myself?
  • Which treatment option(s) is/are the most appropriate, given my chosen lifestyle?
  • Which medications do I want to avoid, because of the likely side effects?
  • Which medications can I afford?
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