Most of us enter medical school wanting to affect change for our patients in profound and positive ways. Though we know we will not achieve this in every case, we hope to provide our patients with definitive diagnoses and successful treatment plans. One problem we often do not anticipate is what it means when our definition of success clashes with that of our patient.
At first glance, this conflict seems inconsequential. As physicians, it will be our duty to ensure our patients’ autonomy. It is our role to provide them with the information they need to make their own decisions about their care and provide our patients with a truly informed consent process. This is straightforward in most cases. Even when the physician disagrees with a patient’s choice, s/he can feel reassured by having provided the patient the space in which to make an independent choice.
On a global scale, however, this philosophical battle between respecting autonomy and doing no harm may not be so simple. In school, we learn about physiology and pathophysiology, which, while complicated to learn, are beautiful in their simplicity; there is a clear-cut normal and an equally indubitable abnormal. Unfortunately, not all aspects of practicing medicine are so straightforward. In some cases, a patient might agree that there is an abnormality but object to the notion that it needs fixing. A simple example is readily evidenced in the relationship between the Deaf community and cochlear implants. Cochlear implants, introduced in the 1980s — hailed by medical professionals as a marvelous invention that would bring people out of a shell of silence and back into the world — are not so universally loved by all of their recipients. While patient autonomy and the age of consent permitted Deaf adults to reject the implants, many in the Deaf community spoke out against their introduction in infants.
The problem lies herein: parents look to physicians for advice. We, as future physicians, seek to fix and cure wherever possible. With that, there are very few hearing physicians who would not recommend a child receive a cochlear implant — it can fix the problem almost entirely. In fact, to those of us born with hearing, not recommending this implant may seem preposterous. Nonetheless, the example of cochlear implants is indicative of an important concern that is amplifying in medicine, as we create new “cures” that need to be implemented prior to adulthood.
As future physicians, we are taught to perceive what is not right and strive to fix it to the best of our ability; this perception may ignore the perspective of our patients, to whom the world is not as black and white. We see a binary: there is a benign thing and a not benign thing — but this is not always the case. Rather, humans exist on a spectrum of which we must be aware as we suggest new treatments and cures. In addition to looking toward our physician colleagues to ask about treatments for certain conditions, we must seek out the individuals with that condition. The Autism community illustrates today what the Deaf community did almost four decades ago: a stark divide between the physicians and those they seek to treat. As future physicians it is incumbent upon us to stop blindly fixing those who may not believe they are broken. This is crucial when we consider permanent “cures” to provide for infants, despite the presence of adults who share their disorder being vehemently opposed. This is not to say we should ignore these disorders but, instead of working to make people more like us, perhaps we should work to make ourselves more accommodating to them and understand why they may not view the “disorder” as something that needs fixing.