You might know someone who got medical treatments that didn't really help -- and may even have hurt. Here's a situation in which a doctor could easily have pressed for more treatment -- but didn't.
Neighbors found Mable, age 89, sitting on the ground in a flowerbed a few hundred feet from her room in the skilled nursing unit of a continuing care retirement community (CCRC). They helped her up, put her in their car and delivered her back to the nursing staff.
Her daughter, June, who lives in another state, fielded a call from the nurse on duty. Mable had fallen and broken her wrist.
June arranged with the CCRC to send a copy of her mother's advance directive with her to the orthopedic specialist. That document gave June the authority to make decisions about her mother's care.
June also prepared a list of questions for the doctor. She included her phone number, and asked that the doctor call her to discuss treatment while her mother was still in the doctor's office.
Many of June's questions had to do with the potential need for surgery and the aftermath, which would be complicated by the fact that her mother suffered from dementia.
When the doctor called, he described the fracture, but his next words surprised June.
"It is very hard for me to say this as a surgeon, but I find that it is best to treat the patient, not the X-ray. As a surgeon, I would like to go in and get the bones perfectly lined up and pin them. But as a doctor, I will tell you that I think that your mother will do better if I just splint her arm for four weeks. She comes across as calm, composed, and pleasant. She does not seem to be in any pain, even with the bone fragments in there. I think it's best to leave it alone."
He continued, "Her arm looks quite shocking right now, with all the bruising. And her wrist will look distorted, always, because the bones won't be aligned perfectly. But the bones will heal, and she will have essentially normal use of her hand. Given her age, her low physical reserves, and her dementia, even something as innocuous-sounding as 'outpatient surgery' could be risky and not work out well for her."
June was quite startled by the doctor's words. She knew that going to the hospital could leave her mother worse off in many ways -- she just hadn't thought that there was any choice.
And she understood what the doctor was saying: was the goal to get perfectly straight bones? Or was the goal to enable her mother to get back to leading as normal a life as she possibly could? Clearly, the second goal was better.
A week later, June got another call from a nurse. Her mother kept removing the sling and the splint that the doctor had put on. They sent her back to see him again, hoping that he would put on a cast.
Instead, he sent her back with fewer wrappings on her arm, not more.
June called the doctor to understand his thinking. He said, "Your mother looked so much better today. She still doesn't have any pain. We had quite a good conversation. The splint was for her comfort only. Since she doesn't like having things on her arm, if I put a cast on it, she would probably try hard to get it off, injuring herself in the process."
He went on to say, "Everyone assumes that every fracture requires a cast. And almost all of them do. But there are exceptions. And I think your mother is one."
He prescribed physical therapy to help with the swelling and the range of motion in Mable's affected arm.
Less than four weeks after her fall, Mable saw the doctor again. Her wrist had healed. She had no pain, and essentially normal use of her hand.
June was grateful that the doctor stuck to the idea that his purpose should be to help her mother live unimpaired -- and didn't give in to the temptation to deliver treatments that might cause her more harm than good.