Several mornings ago, I heard a public service ad on TV urging viewers to go to the ARHQ (Agency for Healthcare Research and Quality) website to learn the ten questions all consumers should be asking their healthcare providers. On the right side on the ARHQ (sponsored by the U.S. Department of Health and Human Services) home page , I found a listing for “10 Questions You Should Ask.” Clicking on this heading takes you to ten general questions for healthcare consumers. From there, you can also “build your own list of questions” depending on whether you are looking for a hospital, deciding whether to have a test or surgery, etc.
There was a time when I was asked not to distribute “Informed Decision-Making” cards in my childbirth classes at a local hospital for fear of antagonizing some physicians. Clearly, this attitude would not be acceptable today. Government agencies (such as ARHQ) and the Joint Commission (with their Speak Up Campaign) along with consumer organizations all urge consumers to take a more active role in their own healthcare. In addition to the trend of encouraging consumers to ask more questions about their proposed care, there is a trend for healthcare providers to provide more information. Instead of providing the risks and benefits of a single proposed therapy in order to obtain “informed consent,” providers are encouraged to engage their patients in “informed decision-making.” This means informing consumers of the risks, benefits, and alternatives of all possible therapies for a certain condition. A back surgeon needs to discuss conservative treatment along with surgical options with his patients. Contrary to what some physicians believe, research indicates that consumers will choose less invasive treatments before surgical ones.
If you are not already doing so, I urge you to develop and to distribute your own list of questions to students attending your childbirth classes. I like to print these questions on business cards (available at office supply stores) so that both pregnant women and their partners can place the cards in their wallets. Teri Shilling, director of Passion for Birth, has developed a card with the acronym B-R-A-I-N. I have attached a copy of her card below.
INFORMED DECISION-MAKING QUESTIONS
1. Is this an emergency, or do we have time to talk?
2. What would be the benefits of doing this?
3. What would be the risks?
4. If we do this, what other procedures or treatments might we end up needing as a result?
5. What else could we try first or instead?
6. What would happen if we waited an hour or two (a day or two, a week or two, etc.) before doing it?
7. What would happen if we didn’t do it at all?
I look forward to the day when all anesthesiologists will discuss the availability of a warm tub along with the option of epidural analgesia and to the day when all expectant parents will feel comfortable and confident asking the questions they need to ask in order to make fully informed decisions.