For any health care professional, a typical day in the hospital brings about its unique challenges. Depending on the patients that we see, one second the situation can be routine, and the next second, it can become complex. In the midst of this flux, there is an expectation for us to make important decisions, with the speed of these decisions dependent on how a patient is doing at a given time. We are called to make judgments based on the medical information we have at a given moment, and the hope is that the judgment we make leads to clinical improvement now and ultimately in the future as patients continue to recover.
In the process of making these judgments, many times we are made aware of the patient’s social situation. People of various walks of life are brought through the hospital doors, either on their own power or with the help of someone else, and when they come across our path, we become a part of their experience, and they become a part of ours. In our care for them, we learn about the good, the bad, and the ugly about their life situations in a way that will hopefully allow us to care for them adequately.
In that process of revelation, however, we may hear something about their lives that can cause us to rethink how we care for them in terms of potential therapeutic options that are offered to them. We hear about their social situation and sometimes it causes us to question whether they would be able to adhere to a particular medication regimen, or whether they would be able to make follow-up appointments once they are discharged. Their situation may cause us to start to make judgments, but in a different, and potentially negative way.
Sometimes, the stakes of an intervention are high enough that trying to predict the future actions of a patient is necessary to prevent an option that may be harmful to them without adequate following of instructions after their discharge. There are other times, however, where preconceived notions of certain patients could cause us to not have an optimistic look on how the patient will do after their hospitalization.
This is particularly noticeable when we deal with patients who may not have seen a doctor in a while, or other patients who may come to the hospital with the same complaint frequently in the hopes of seeking a particular treatment despite a negative workup. If their social situation is unstable, it may cause us to think that they may not be as likely to be adherent to a certain treatment or to follow-up with a physician compared to other people from a more stable social background. In these assumptions, there is a potential danger of our own preconceived notions affecting our view and subsequent care of certain patients. It is this type of judgment that we need to be aware of and to be wary of, so that the decisions we make regarding our patients are based mainly on what we are seeing from a medical standpoint as opposed to a social standpoint.
Earlier, I mentioned that judgment is a part of our job as health care professionals as we take care of patients. If we look at it deeper, there are two types of judgment that can be at play. One type of judgment is based on the medical information we have at our fingertips at a given moment, and the other type is based on certain assumptions we may make about other patients that help us to predict their future actions once they leave the hospital. However, it is the second type of judgment we need to keep an eye on and potentially leave behind, so that any potential biases on our part with regards to particular social situations will have a limited role in our medical decision making. At the end of the day, our patients depend on us making good clinical decisions based on the judgments we make. Let us continue to use the type of judgment that helps to enhance our care, and in the process leave behind the type of judgment that can hinder our care.
Chiduzie Madubata is a cardiology fellow.
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