What would you do doc?

One of the commonest questions I get asked as an oncologist is “what would you do doc?” or “what would you do if it were your mother?”

The more I get asked this question the more I wonder about its’ relevance as more often than not the patient/family goes with the option I wouldn’t necessarily recommend.

Usually this question is asked in the context that I am discussing the pros and cons of nth-line therapy for a incurable, metastatic cancer. The option of palliative care is always available and in many circumstances, in my view, is the best option. A lot of nth-line treatment options have statistically significant but clinically marginal benefit and being the expert who as looked after a lot of people I’d usually go the palliative care route as my own preference.

But this is my preference and it is informed by my world view. I think the flaw in the “what would you do doc?” question is that the real question is “what would you do if you were me?”….well the answer to that is I’m not you and I don’t actually know what your preferences are. I encourage patients to try and work out what kind of patient they are and what their preferences are: are they a “do everything possible person” or a “quality of life is my priority person”. Sometimes I already know the answer to this as I have known the patient for a long time.

The most important thing, providing you stick to the ‘do no harm’ rule, is that there is no medically correct answer but there is a right answer for the individual.

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