The Open Threat from my Doctor

by Jeanette

Thanks for sharing your story.

During my cancer episode I had a referral to a chemo oncologist and a radiation oncologist. They both recommended treatment. I felt the need to get a second opinion on my need for chemo and was told that traditionally my kind of cancer was treated with radiation only, so I ended up opting out of the chemo. As a result, I was pressured to drop the worst of the 3 chemo drugs in my treatment plan and do just the other two. I politely refused all chemo.

The chemo oncologist later attested to the fact that he was using very aggressive treatment and didn't mention anything about putting "refused treatment against medical advice" on my medical record. Something inside me had told me not to do the chemo so I followed my "inner knowing". I felt like I got affirmation later that I chose the right path because I learned the oncologists at that cancer center got paid on commission--the more chemo they give, the more they get paid.

I continued my radiation treatment plan through 28 external treatments and 3 implants. The protocol for the external radiation was 30 treatments, and I refused to take the last two because my body was so very ravaged.

My radiation oncologist told me if I didn't finish he would put in my medical record that I refused treatment against medical advice. He never explained what that meant or the what the consequences of it could be, and I was too sick to care to ask. How much trouble am I in for having that in my record?

Comments for The Open Threat from my Doctor

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Against Medical Advice or "AMA"
by: Elle

Dear Jeanette,

Thanks for your submission to The Body-Mind-Soul Disconnect. I commend you for trusting your "Inner Knowing." It is always right.

That both of your oncologists used the threat of placing 'refused treatment AMA' is very patronizing and paternalistic, isn't it? This is a very common occurrence in the medical arena and your case is not unusual.

We are socialized to believe that our opinions about our own health care do not count. Please rest assured that as health care professionals we are trained that an adult always has the right to accept or refuse treatment. Nurses know this and accept this. Most doctors haven't gotten it yet.

I believe that doctors are trying to protect themselves, due to liability, if the treatment should fail. Unfortunately, our society is too quick to blame the doctor and sue him/her if something goes wrong. So the doctor must ensure that the patient understands the recommendation and makes the decision. He then charts, 'refused treatment AMA' to cover himself.

A better approach by the doctor, would be to acknowledge your right to make the decision. Re-iterate his/her recommendation, to ensure you understand, then state that he/she is recommending the treatment based on his knowledge and experience. He doesn't have to tell you what he is going to chart. That was a threat to you to try to succumb to his opinion.

So you see, you are in no trouble at all. You are just exercising your right to make an informed decision. Just make sure you get all your questions answered so you truly are informed!

When you throw in the reimbursement issue, it is sad indeed, but oh so true. Medical treatment should never be reinforced by money. It would take a very conscious physician to stay aware of this dilemma. Does anyone have any ideas how society can address this problem?

Health and Healing to all!

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