Last Tuesday, I had my first MRI. The purpose was to positively diagnose a small non-malignant tumor that I will be able to treat with an out patient procedure this fall. Having never had one before I was struck but the intense noise and the claustrophobic feeling of not being able to move for 40 minutes. It got me thinking about how much more difficult the test would be if I was in a different state of health.
For example, my Grandmother has Alzheimer's. She wouldn't be able to remember the directions to stay still or remember after a few minutes why she was even there or what the loud noises were about. How scary!
When we think about the kind of health care choices we may need to make for loved ones who become disabled or the kind of choices we may need someone to make for us, we tend to think of the big choices like life support. But there are lots of little choices to be made as well and one area that can be challenging is the area of diagnostic testing.
There are many medical tests that are routinely ordered as people age, like mammograms or colonoscopies. These tests, while not always pleasant, are wonderful at catching diseases early and allowing treatment. Other tests - like CT Scans and MRIs - are ordered routinely in response to symptoms and can be helpful in allowing for accurate diagnosis and possible treatment of a variety of problems. Because these test are routine and rarely involve a life threatening risk, they are often ordered and given with very little thought or deliberation. However, for people in some medical conditions they may not be appropriate or as routine and safe as they otherwise might be. For example, people with dementia often need anethesia to remain still and that carries much greater risks than an MRI for a health individual. The tests may also be more traumatic and destabilizing to individuals who don't understand them and require regular routines.
If you are acting as a health care agent and are presented with an order for your loved one to undergo one of these tests, in addition to the normal informed consent questions about risk consider asking some of these questions as well.
(1) Why is this test necessary?
(2) What information would this test give us that we don't have now?
(3) If this test identified a problem, how would that problem be treated?
(4) In what ways might this test be painful or frightening?
(5) Would it require sedation?
(6) Could symptoms be addressed and comfort provided without this test?
These questions can help you better understand the purpose, benefits, and downsides of testing. Diagnosis and treatment is the purpose of most modern medicine. It is part of the medical culture to always want to know the cause of symptoms. But that may not always necessary? If your loved one has reached a point of ill health or advanced dementia where you would not choose to have them undergo surgery or chemotherapy if they were diagnosed with colon cancer and would instead just choose comfort care measures, then how important is it to have that diagnosis? If you don't need the diagnosis, why do the colonoscopy?
In my case the test confirmed my doctors' original diagnosis of a hemangioma. While not a significant problem now, if left untreated in five years it would begin to be painful and impact my facial control. The treatment will be painful for a few weeks but permanently take care of the process. Given my age and health it was an easy choice to do the treatment and to do the testing. If I were making health care choices for my grandmother, I might make a different choice. It would be helpful in making such a choice that my grandmother was very good about discussing her feelings about treatment options when she was able to make good choices.
At Phinney Estate Law we work with client to develop estate plans that properly delegate their health care choices if they become disabled AND to provide good direction to their appointed agents. We also work with clients to make good choices when serving as health care agents or guardians. Over the next few weeks we will be posting information about these important topics.
If you want to begin working on your planning or need advice when serving as an agent, contact us to set up a free 1/2 hour consultation at [email protected] or (206) 459-1908.
For example, my Grandmother has Alzheimer's. She wouldn't be able to remember the directions to stay still or remember after a few minutes why she was even there or what the loud noises were about. How scary!
When we think about the kind of health care choices we may need to make for loved ones who become disabled or the kind of choices we may need someone to make for us, we tend to think of the big choices like life support. But there are lots of little choices to be made as well and one area that can be challenging is the area of diagnostic testing.
There are many medical tests that are routinely ordered as people age, like mammograms or colonoscopies. These tests, while not always pleasant, are wonderful at catching diseases early and allowing treatment. Other tests - like CT Scans and MRIs - are ordered routinely in response to symptoms and can be helpful in allowing for accurate diagnosis and possible treatment of a variety of problems. Because these test are routine and rarely involve a life threatening risk, they are often ordered and given with very little thought or deliberation. However, for people in some medical conditions they may not be appropriate or as routine and safe as they otherwise might be. For example, people with dementia often need anethesia to remain still and that carries much greater risks than an MRI for a health individual. The tests may also be more traumatic and destabilizing to individuals who don't understand them and require regular routines.
If you are acting as a health care agent and are presented with an order for your loved one to undergo one of these tests, in addition to the normal informed consent questions about risk consider asking some of these questions as well.
(1) Why is this test necessary?
(2) What information would this test give us that we don't have now?
(3) If this test identified a problem, how would that problem be treated?
(4) In what ways might this test be painful or frightening?
(5) Would it require sedation?
(6) Could symptoms be addressed and comfort provided without this test?
These questions can help you better understand the purpose, benefits, and downsides of testing. Diagnosis and treatment is the purpose of most modern medicine. It is part of the medical culture to always want to know the cause of symptoms. But that may not always necessary? If your loved one has reached a point of ill health or advanced dementia where you would not choose to have them undergo surgery or chemotherapy if they were diagnosed with colon cancer and would instead just choose comfort care measures, then how important is it to have that diagnosis? If you don't need the diagnosis, why do the colonoscopy?
In my case the test confirmed my doctors' original diagnosis of a hemangioma. While not a significant problem now, if left untreated in five years it would begin to be painful and impact my facial control. The treatment will be painful for a few weeks but permanently take care of the process. Given my age and health it was an easy choice to do the treatment and to do the testing. If I were making health care choices for my grandmother, I might make a different choice. It would be helpful in making such a choice that my grandmother was very good about discussing her feelings about treatment options when she was able to make good choices.
At Phinney Estate Law we work with client to develop estate plans that properly delegate their health care choices if they become disabled AND to provide good direction to their appointed agents. We also work with clients to make good choices when serving as health care agents or guardians. Over the next few weeks we will be posting information about these important topics.
If you want to begin working on your planning or need advice when serving as an agent, contact us to set up a free 1/2 hour consultation at [email protected] or (206) 459-1908.
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