Recognizing that some treatment interventions or medications might be acceptable to one individual but not to another, the physician is prepared to present options while respecting the patient's right and need to be part of the decision-making process. The physician thus conveys to the patient and family the important message that they will not be alone in their efforts to cope with the disease and make meaningful choices for themselves.
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| Help Multiple Sclerosis |
Many people with MS and their family members become overwhelmed at one time or another by the extent of the physical and psychosocial problems that can be created by MS. One of the physician's priorities is to reduce this overwhelming feeling by helping people identify smaller, more manageable problems that have workable solutions. This approach is particularly useful for the family that comes to the doctor demanding, for example, either a cure for the person's MS or that the person be made able to walk again. The family is frightened by the disease and unable to focus on any goal other than total eradication of the problem.
Physicians who fall victim to these demands may develop feelings of failure that cause them to withdraw from the family and the patient. Rather than "buying into" the family's demands for a cure or a miracle, the physician must help the family recognize and experience its grief over the losses they are experiencing, and then focus on more specific problems that can be addressed satisfactorily. Careful management of common symptoms (e.g., fatigue, spasticity, pain, bowel and bladder problems, sexual dysfunction, and psychological changes) can significantly enhance a person's comfort, independence, productivity, and overall quality of life.
In this brief description of the doctor's role in the treatment of chronic disease, the family has been mentioned several times. In marked contrast to the doctor-patient relationship in acute illness, which may never involve family members at any point from diagnosis to cure, the ongoing collaborative relationship in chronic illness often involves one or more family members (or "significant others"). Healthcare providers who are experienced in MS care are well aware of the impact of this type of chronic illness on the entire family. From the time of diagnosis onward, patients and family members all need to accommodate the changes brought by MS into their lives.
With careful attention to issues of confidentiality, privacy, and autonomy, the physician, patient, and family members decide who in the family will give and receive medical information, and who will have a say in treatment planning. The rationale for any of these decisions needs to be discussed in detail and reassessed as family roles evolve, or whenever changes in the patient's condition or in the family's ability or willingness to participate in the treatment process necessitate a change. Thus, for example, the role of parents in the treatment decisions concerning a 17-year-old child with MS will begin to change as the child grows into maturity and wishes to make more decisions independently.
Similarly, family members who were initially less involved in treatment decisions may need to become more involved if the person with MS becomes cognitively impaired to a degree that interferes with the decision-making process. To find out more, you can check out Help Multiple Sclerosis.