Wednesday, August 30, 2006

Medicine for our mothers

We hear it about once a week on wards, at times when particularly troubling or trying decisions arise regarding patient care. Usually, it’s the attending who poses the question, but it’s always spoken from a more senior to less senior team member, as it carries a subtle implication that the currently proposed plan may not be quite good enough: “If it were your mother, what would you do?” The effect that this question has upon the team is both striking and predictable. (It does rely on the assumption that the team members love their mothers, but would they really have become doctors if they didn’t?) Several moments of chin rubbing, head scratching and soul searching ensue, after which it is generally agreed to raise the level of care or renew efforts with yet another attempt at diagnosis or therapy. Occasionally the question instead spurs a move towards patient comfort or palliation. All involved are reassured that the patient is getting the best possible care because it is what they would have done for their own mothers.

The mother hypothetical is a ritual of medicine that I have participated in countless times, although I’ve never raised the question myself. Somewhere between my 4th year of medical school and internship its great irony struck me. As physicians we are forbidden from practicing medicine on our mothers for the very reason that when it comes to them, we are completely incapable of reason, rationality, or measured decision making. Yet with our most difficult decisions, at the times when we most should be relying upon reason to guide us, we instead emotively plea for guidance to the specters of our beloved mothers. Oddly enough, it usually helps. Still, I have to wonder, are we asking the right question? Does mother know best? Perhaps our decision making would be better if we instead pondered about Uncle Albert. Or, an even more novel concept, what if we just asked what was best for that patient?