Medical Decision Making with BJ Miller
Our podcast is hosted on Spotify and Anchor.
Gone are the days when you could hand yourself over to your doctor and hope for the best. There are too many treatments with too many consequences and you need to have a good handle on the science of prognosis, treatment trade-offs, and healthcare's momentum and assumptions. In this video BJ Miller outlines what to consider when making decisions and explains aspects of the healthcare system you need to understand to do so.
Show Notes:
0:00 Introduction
2:54 Understanding the American healthcare system
3:30 The momentum of the healthcare system
4:30 It’s ok to say “no" to treatment
6:12 Taking stock of your situation: what are your resources?
7:26 How to consider a prognosis
8:07 How much do you want to know?
8:50 Defining what you want to know
9:34 Prognosis declaration: a tool for communicating with your doctor.
11:21: Understanding “goals of care”, what do you hope to gain?
13:20 Sharing your decisions with people who are close to you
14:35 Summation of medical decision making process
16:43 Understanding clinical trials and how they work
21:52 Understanding technical terms and communication with doctors
24:48 What to do with conflicting prognoses from doctors?
26:52 Navigating the healthcare system without advocates or proxies (Canada)
28:36 Reaching out social services for help
28:58 Importance of completing an Advance Directive when solo
29:30 Utilizing hospice when alone or palliative care
30:12 How do you find the best candidates to discuss medical decisions?
32:20 Recording your medical decision conversations with family or doctors
33:37 Should you have an advance directive or a POLST?
37:05 Strategies for advocating for yourself if a proxy is not available?
39:45 Deferring to doctor’s suggestions for treatment
43:00 Prognosis Declaration form - using it to set boundaries for you and your doctor
45:18 Getting 2nd and 3rd decisions after a prognosis
47:20 Balancing “hope" and a prognosis
50:19 What is VSED: Voluntary Stopping Eating and Drinking
53:30 Suggestions for things to consider when making medical decisions
55:28 Relative risks to consider and understanding trade-offs
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