Clinic speak: humanising clinical decision making

What would you do if your daughter had MS? #MSBlog #MSResearch #ClinicSpeak

Question: What would you do if your daughter had MS? 


“I might get asked this question 5 or 6 times a year, usually in relation to prescribing DMTs or consenting for clinical trials. I never answer the question because I honestly don’t know the answer. I simply sit on the fence and state that if it was my daughter I would hope that she was informed enough to make the decision herself. The following article in this weeks NEJM tackles this issue very well. It is worth a read.”


David Korones. What Would You Do if It Were Your Kid? N Engl J Med 2013; 369:1291-1293.

Some excerpts:


…. I suppose we’ve all been asked that question: What would you do if it were your child, your mother, your brother, your husband? Sometimes I’ve asked people what they mean by this question — and been answered by puzzled looks saying, “What do you mean what do I mean? I just want to know what you would do if it were your kid!” People may ask this question because they reasonably assume that the option we’d choose for those we love the most is the best option and therefore the most appropriate for them. They may also be seeking to humanize us, to make our involvement personal. They’re entreating us to approach them or their relative not just as another case, but as a human being with as much value as our own sons and daughters, mothers and fathers. It’s another way of asking for guidance, a plea to share with them, as a partner, the heavy burden of decision making….

…… They may not appreciate, however, that when it comes to making medical decisions for our own families, we may draw on our emotions at least as much as the objectivity required for sound medical decisions. In addition, medical decisions, particularly regarding goals or limits of care, are seldom straightforward and depend on the medical scenario, the patient, the family, and their culture and philosophy of care. What I might want for my daughter (and what she might want) may be very different ……

…… So how do we answer? How do we balance our professional judgment with the very personal judgments that such a question asks us to make? We could avoid answering altogether, explaining that since we’re not in the same situation we cannot possibly know what we would do. But though there may be truth in that answer, it denies our patients an important piece of information that may help them make an agonizing decision. Another option is to answer as honestly as possible…….

…… The “What would you do?” question is daunting but common. Though sometimes the personal and professional answers converge, other times the question creates conflict for clinicians. Perhaps before we discuss difficult decisions with patients or families, we should ask ourselves how we would answer that question. We should remember that our patients ask it because they’re seeking guidance, not a menu of options, and I believe we should answer as honestly as possible. Perhaps it’s not such a bad thing if our perspective as a parent or a spouse is a part of our answer. Sharing a little piece of ourselves with patients and families humanizes us at a time when they need us to be human and sends the message that we are all in this together……

9 thoughts on “Clinic speak: humanising clinical decision making”

  2. Would be interesting to know if David Korones has been taken to court yet….This is the unfortunate reality of the medical industry today: Your best option is to keep your mouth shut, otherwise running massive liabilities for yourselves.My experiment as a patient is that medical professional in emerging market (where medical unions are quite powerful in lobbying the judicial and political bodies against prosecuting doctors) gives advice more freely and more humanely.I observed this behaviour on several occasions. It does make sense….

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    1. "Would be interesting to know if David Korones has been taken to court yet…."Please elucidate.

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  3. I think people ask "what would you do if it was your daughter" because they want the benefit of your intuition as well as your scientific knowledge. I know how science works and anecdote is unreliable. But I want a combination of both from my doctors when I can get it.

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  4. It was a humane viewpoint. However, 'the seeking guidance' take is a little paternalistic. I would ask this question or want my loved ones to ask it because i would want to know what secret 'magic potion' in the Phase 1 trial box that you have access to and I may not – I know that ethics would prevent you from answering this question honestly – however I suspect that if the rubber hit the road for your child you might be able to access and be willing to try the riskier therapies. There surely comes a point in the life or death dichotomy that you as neurologist would "do whatever it takes' – I feel that as a patient I may not have that option and would at least appreciate a specialist for being honest enough to acknowledge this point. Would you for instance 'assist' prescribing a treatment which has completed a Phase 1 trial, and has proven safety record in other diseases on the basis that this was the last 'known' option with as yet to be determined odds of success and you had a pleading patient willing to sign whatever waiver or indemnity you wanted.

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    2. "What is concerning is that Lord Saatchi appears to have been told that doctors are unable to make progress in cancer treatments because of the fear of medical negligence litigation."

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