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I was talking to a good friend today. Her cousin has been carrying a benign ovary tumor for years, and it’s getting bigger; according to my friend, the cousin has to wear loose clothes, as her belly is burging out. She has been seeing doctors for the tumor; in fact, a few years ago, the doctors were planning a surgery to have the tumor removed, but she kept postponing the surgery with different excuses, until it never happened. Now, although my friend is pretty close to her cousin, the cousin can be a very private person and prefers not to talk too much about it.

 

Let me add that money is not the concern here, as the cousin’s family has pretty good health insurance coverage. She’s married with a teenage kid, if it matters.

 

My concern is that the continued growth of the tumor may affect nearby organs or blood vessels, even if it’s benign. I’m not sure why her husband (and to an extent her kid) wouldn’t just drag her to do the surgery. Mostly, I’m just very puzzled why the cousin would avoid the surgery like that? What are the usual psychological hangups??

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My mother is so scared of anesthesia that I'm sure she'd opt out of that surgery. I'm not even sure she'd do it if the tumor was life threatening.

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CautiouslyOptimistic
My mother is so scared of anesthesia that I'm sure she'd opt out of that surgery. I'm not even sure she'd do it if the tumor was life threatening.

 

Yeah, I was thinking something like that. My daughter is so deathly afraid of needles it's shocking. I think a lot of people are afraid of a lot of different stuff associated with medicine - anesthesia, being cut into, being in pain after surgery, pain medication, etc.

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My mother is so scared of anesthesia that I'm sure she'd opt out of that surgery. I'm not even sure she'd do it if the tumor was life threatening.

 

I see. Did she have negative experience with anesthesia personally?

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thefooloftheyear

For me, it's just a distrust that they are truly acting in the best interests of their patients...Unless you are a filthy rich elite type, most doctors won't ever spend enough time to truly diagnose your condition fully and make a proper recommendation..So what do they do? Diagnose meds, give the standard BS answer....It's almost as bad as taking your car to a mechanic for a noise and all they do is replace your engine...The noise went away, but was it a more extreme measure than was required.??

 

Here is a link to a study just released...Doctors only spend on average 11 seconds listening to a patient..

 

https://www.newsweek.com/doctor-patient-visits-1035514

 

Additionally, the overprescription of meds is a huge problem...For example, if you go see a doctor and he finds you have high blood pressure, he'll prescribe BP meds and send you on your way...He won't look at you and ask you about your lifestyle, as just losing some weight or other dietary /lifestyle changes will often cure a condition of nigh BP.. Why go for the meds first?

 

In many cases the side effects of the medication are worse than the condition its meant to treat...This is a really big problem...

 

Also. I think most people(and maybe even doctors) underestimate the human body's capability of rehabbing itself..I'm not saying this is true in every case, but in many cases it is...I tore my rotator cuff so bad that I could not move my arm at all..Dr said that without surgery the best I could hope for is 25% range of motion...Well...It took over a year of rehabbing it myself, but its back to probably 95% full strength and 100% full range of motion...No surgery...

 

SO in the case of the OP..>Who knows? Maybe she feels the same way I do, a general lack of trust..Or maybe its something else...My only point is that many people just don't feel all that confident in the opinions of doctors...Sure, then we all take that risk if we are wrong, but I do know that this attitude exists..

 

TFY

Edited by thefooloftheyear
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A lot of valid points here. Personally, I’m always very picky about choosing my physicians (the quality just varies too much); I also won’t hesitate in getting second opinions, and most importantly, taking an active part in understanding my own health, instead of blindly buying what my doctors say. Actually western medicine tends to be on the invasive side; moreover, sometimes, it fails to look at the overall health of a person as a whole.

 

But in my the case of my friend’s cousin, surgery seems to be the sensible route. I have heard of cases in which the continued growth of ovarian tumors eventually becomes life threatening. In addition, the surgery becomes more complicated the longer she waits.

 

For me, it's just a distrust that they are truly acting in the best interests of their patients...Unless you are a filthy rich elite type, most doctors won't ever spend enough time to truly diagnose your condition fully and make a proper recommendation..So what do they do? Diagnose meds, give the standard BS answer....It's almost as bad as taking your car to a mechanic for a noise and all they do is replace your engine...The noise went away, but was it a more extreme measure than was required.??

 

Here is a link to a study just released...Doctors only spend on average 11 seconds listening to a patient..

 

https://www.newsweek.com/doctor-patient-visits-1035514

 

Additionally, the overprescription of meds is a huge problem...For example, if you go see a doctor and he finds you have high blood pressure, he'll prescribe BP meds and send you on your way...He won't look at you and ask you about your lifestyle, as just losing some weight or other dietary /lifestyle changes will often cure a condition of nigh BP.. Why go for the meds first?

 

In many cases the side effects of the medication are worse than the condition its meant to treat...This is a really big problem...

 

Also. I think most people(and maybe even doctors) underestimate the human body's capability of rehabbing itself..I'm not saying this is true in every case, but in many cases it is...I tore my rotator cuff so bad that I could not move my arm at all..Dr said that without surgery the best I could hope for is 25% range of motion...Well...It took over a year of rehabbing it myself, but its back to probably 95% full strength and 100% full range of motion...No surgery...

 

SO in the case of the OP..>Who knows? Maybe she feels the same way I do, a general lack of trust..Or maybe its something else...My only point is that many people just don't feel all that confident in the opinions of doctors...Sure, then we all take that risk if we are wrong, but I do know that this attitude exists..

 

TFY

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Well it's definitely fear or some sort of phobia and phobias are not rational. People who have phobias know that they are not being rational but their terror is not something that they can just turn off.

 

I myself, have fears of medical procedures. I don't want to be put under, I hate hospitals and the thought of having to turn my life over to the care of others just really makes me irrationally stressed and fearful. Just going to the dentist is a huge drama for me...lol.

 

However there are therapists who specialize in treating phobias. Since the woman in your OP is not in an immediate life threatening situation and you say money is not an issue, maybe you could suggest that she spend a few months on therapy to help her face her fear and get through the procedure. Maybe even a few sessions with a hypnotist would help.

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amaysngrace

Some people are really strange about separating themselves from body parts. If it's now a part of her body she may have grown an attachment to it in a weird sort of way.

 

She may also be trying a more holistic approach rather than going under the knife.

 

Perhaps in her mind, if her body can house a baby her organs having pressure put on them is no big deal.

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Surgery is scary, and risky. Major abdominal surgery carries additional risks. Granted, the benefits of the surgery are likely to exceed the risks (otherwise a reputable surgeon would never advise it), but it doesn't change the fear that you feel, knowing that after you go under you may never wake up again.

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maybe she is scared or has intense anxiety about surgery in any form??

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Surgery is scary, and risky. Major abdominal surgery carries additional risks. Granted, the benefits of the surgery are likely to exceed the risks (otherwise a reputable surgeon would never advise it), but it doesn't change the fear that you feel, knowing that after you go under you may never wake up again.

 

Exactly! It's totally reasonable to be fearful or at least a tad nervous about having surgery. My biggest fear would be the pain afterwards, followed by potential complications, followed by potential death.

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  • 4 weeks later...

My aunt died of a slow growing tumour in her breast over the span of almost ten years. They found out when it was stage 0, she was married to a wealthy man and was offered treatment at top hospitals. She refused treatment to the very end and died in palliative care. She left one son behind in his twenties who spoon fed and cleaned her to her last very painful and agonizing day.

 

This topic hits very close to home but it's not even the above that bothers me. Someone very close to my heart at this very moment is going for cancer treatment(surgery and chemo) as well and was diagnosed in spring this year for an aggressive and spreading tumour.

 

I'm sorry, OP, that you have to go through that and see your cousin refuse treatment. What many people don't realize is that treatment may not be approved for all blood types or bodies. You may think that you have options when illness hits but be faced with a completely different reality when the doctors speak with you about your future (or what's left of it). My advice: DON'T take offered treatment lightly and encourage your loved ones to seek several opinions and get the answers they need in order to make an informed decision. DON'T die from a situation that can be treated or if the advantages outweigh the disadvantages. Having faced cancer several times with those I love I can honestly say it's not fair to everyone involved and while I completely respect personal decisions, consider the lives of your loved ones who are with you every step of the way.

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Thank you for sharing your personal stories. I have heard stories of women refusing to have surgical removal of part of their female organs because they feel that they’ll be no longer like a woman.

 

My aunt died of a slow growing tumour in her breast over the span of almost ten years. They found out when it was stage 0, she was married to a wealthy man and was offered treatment at top hospitals. She refused treatment to the very end and died in palliative care. She left one son behind in his twenties who spoon fed and cleaned her to her last very painful and agonizing day.

 

This topic hits very close to home but it's not even the above that bothers me. Someone very close to my heart at this very moment is going for cancer treatment(surgery and chemo) as well and was diagnosed in spring this year for an aggressive and spreading tumour.

 

I'm sorry, OP, that you have to go through that and see your cousin refuse treatment. What many people don't realize is that treatment may not be approved for all blood types or bodies. You may think that you have options when illness hits but be faced with a completely different reality when the doctors speak with you about your future (or what's left of it). My advice: DON'T take offered treatment lightly and encourage your loved ones to seek several opinions and get the answers they need in order to make an informed decision. DON'T die from a situation that can be treated or if the advantages outweigh the disadvantages. Having faced cancer several times with those I love I can honestly say it's not fair to everyone involved and while I completely respect personal decisions, consider the lives of your loved ones who are with you every step of the way.

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Past experience.

 

Working in the medical profession.

 

Psychological blocks.

 

Fear of bankruptcy/loss of job/income, etc.

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  • 2 weeks later...

I'd say one of the key things is to double check she really has been explained the procedure to her satisfaction; if she is really shy and reticent pick her best friend to do it. Yes, I realize many doctors have gotten a bad rap for over-recommending surgery and over-prescribing, but try to dig out what exactly her hesitation is coming from. All the previous people who posted here have perfectly reasonable points as to why people hesitate to choose surgery.

 

Nobody wants your friend to get super sick because she was shy and said "I didn't know how serious it was".

Edited by Garcon1986
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Usually there's someone in their early life that influenced them that way. My first thought was to answer "they're stupid," but I have a friend who is that way and it's because her mom died at a young age and her mom was a nurse, so she selectively remembers certain thing her mom said and then also how medicine failed her in the end. So her and her sister have a "I hate doctors and medicine" mindset and all sorts of superstitious beliefs and old wive's tales about different things, like her sister will only cook with glass cookware.

 

Her sister wouldn't go to the doctor until she literally couldn't walk. And then because he sister broke the pact, my friend went. She had suffered from an inflammatory autoimmune disease her whole life and if she's been treated early, it never would have reached the proportions it did. When she finally went to the doctor, after waiting until it was advanced, the only course of treatment were very serious drugs with side effects, cancer type drugs. So she created what she most feared by not going until it took over.

 

What's totally irrational about her is she doesn't trust or believe doctors, but she trusts and believes this old health newsletter that exists to sell natural supplements that she's subscribed to for years. I flip through it sometimes when I'm over there and I noticed one time I read an article and it said one thing and then a year later, it completely said the opposite on the same subject. I mentioned that to her. She had noticed, but it didn't matter.

 

I have one friend who is afraid of one drug because her relative didn't start getting treated for the problem until it was well advanced and then developed complications (plus he drinks too much) and she blames the drug instead of his drinking and already being acute before he got treatment, and she's a very smart lady. I'm on the drug and she was shrieking about it to me. All my doctors, including a specialist, seem confident this is the best thing and say when used in the way it's prescribed, it has no serious down sides.

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As a healthcare professional, are you also concerned that there might be legal implications in case the patient who has refused essential treatment may blame you when she has to suffer from its consequences?

 

I'd say one of the key things is to double check she really has been explained the procedure to her satisfaction; if she is really shy and reticent pick her best friend to do it. Yes, I realize many doctors have gotten a bad rap for over-recommending surgery and over-prescribing, but try to dig out what exactly her hesitation is coming from. All the previous people who posted here have perfectly reasonable points as to why people hesitate to choose surgery.

 

Nobody wants your friend to get super sick because she was shy and said "I didn't know how serious it was".

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Yes that is a risk. I'll go through the most famous examples - there are whole careers dedicated to this sub-specialty of medicine, as it's a complicated business with a long history.

 

In internal medicine/ adult medicine land, you almost universally cannot force a patient to do anything. You must obtain informed consent for everything. The idea is to convince your patient, the intervention you plan on is in your best interest.

 

One of the most important examples of being allowed to force someone to undergo a medical examination against their will, is something called the Baker Act. Here's the general criteria of the Baker act (quoted from Wikipedia):

 

This type of forced examination is only used of course under very restricted circumstances.

 

Reason to believe that the person has a mental illness; refusal of voluntary examination; the person is unable to determine whether examination is necessary. Criteria are not met simply because a person has mental illness, appears to have mental problems, takes psychiatric medication, or has an emotional outburst. Criteria are not met simply because a person refuses voluntary examination. Criteria are not met if there are family members or friends that will help prevent any potential and present threat of substantial harm.



The decisive criterion, as stated in the statute, mentions a substantial likelihood that without care or treatment the person will cause serious bodily harm in the near future. ("Substantial" means ample, considerable, firm or strong.)

To further clarify this point of substantial likelihood, there must be evidence of recent behavior to justify the substantial likelihood of serious bodily harm in the near future. Moments in the past, when an individual may have considered harming themselves or another, do not qualify the individual as meeting the criteria. ("Near" means close, short, or draws near.)[5]

 

In pediatrics, you are generally not allowed to withhold lifesaving treatment

from your child. The most famous example that lawyers and pediatricians cite is the Jehovah's witness trying to withhold life saving blood transfusions for a post surgical patient who will very likely die without them. It is actually unlawful to do so. Typically this conflict occurs in a hospital and the entire legal team and representatives from the medical team will convene to obtain a court order to give the transfusion. However, that same Jehovah's witness parent is perfectly alright to refuse blood for herself even if she would die. She just has to sign a paper saying she understands the consequences of doing so. The medical team is obligated to tell the immediate relatives of such a patient (with the bounds of HIPAA/ patient privacy) if that is the case, of the consequences.

 

On the other extreme, there are parents in pediatrics who withhold definitive (but not life sustaining) treatment from their children so that they can game the Medicaid system and receive disability checks for themselves. That's the dark side of pediatrics. That makes me really sad inside when I see this, but fortunately it's rare. Most of the time you get to see the joy in a kid's eyes when you solve their medical problem and you can high five them on the way out the door. Most often the reason a family in a pediatric hospital gets upset with the pediatrician is because they believe some concern of theirs is not being heard. Once the concern is fully acknowledged, usually the conflict melts away. An easy example of this is a medical team ordering overnight vital signs on a patient who has been in the hospital a long time. If the medical team is secure in their assessment of how well the patient is, they are fine to stop asking for overnight vital signs if the underlying concern, is that the family and the child haven't gotten enough sleep for weeks.

 

 

There are many fine gradations to your question which is certainly a good one. It's all part of what we do as a medical team.

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Thanks for the helpful info. In many cases, though, the situation is not life or death yet (like the cousin’s situation in my OP).

 

Yes that is a risk. I'll go through the most famous examples - there are whole careers dedicated to this sub-specialty of medicine, as it's a complicated business with a long history.

 

In internal medicine/ adult medicine land, you almost universally cannot force a patient to do anything. You must obtain informed consent for everything. The idea is to convince your patient, the intervention you plan on is in your best interest.

 

One of the most important examples of being allowed to force someone to undergo a medical examination against their will, is something called the Baker Act. Here's the general criteria of the Baker act (quoted from Wikipedia):

 

This type of forced examination is only used of course under very restricted circumstances.

 

Reason to believe that the person has a mental illness; refusal of voluntary examination; the person is unable to determine whether examination is necessary. Criteria are not met simply because a person has mental illness, appears to have mental problems, takes psychiatric medication, or has an emotional outburst. Criteria are not met simply because a person refuses voluntary examination. Criteria are not met if there are family members or friends that will help prevent any potential and present threat of substantial harm.



The decisive criterion, as stated in the statute, mentions a substantial likelihood that without care or treatment the person will cause serious bodily harm in the near future. ("Substantial" means ample, considerable, firm or strong.)

To further clarify this point of substantial likelihood, there must be evidence of recent behavior to justify the substantial likelihood of serious bodily harm in the near future. Moments in the past, when an individual may have considered harming themselves or another, do not qualify the individual as meeting the criteria. ("Near" means close, short, or draws near.)[5]

 

In pediatrics, you are generally not allowed to withhold lifesaving treatment

from your child. The most famous example that lawyers and pediatricians cite is the Jehovah's witness trying to withhold life saving blood transfusions for a post surgical patient who will very likely die without them. It is actually unlawful to do so. Typically this conflict occurs in a hospital and the entire legal team and representatives from the medical team will convene to obtain a court order to give the transfusion. However, that same Jehovah's witness parent is perfectly alright to refuse blood for herself even if she would die. She just has to sign a paper saying she understands the consequences of doing so. The medical team is obligated to tell the immediate relatives of such a patient (with the bounds of HIPAA/ patient privacy) if that is the case, of the consequences.

 

On the other extreme, there are parents in pediatrics who withhold definitive (but not life sustaining) treatment from their children so that they can game the Medicaid system and receive disability checks for themselves. That's the dark side of pediatrics. That makes me really sad inside when I see this, but fortunately it's rare. Most of the time you get to see the joy in a kid's eyes when you solve their medical problem and you can high five them on the way out the door. Most often the reason a family in a pediatric hospital gets upset with the pediatrician is because they believe some concern of theirs is not being heard. Once the concern is fully acknowledged, usually the conflict melts away. An easy example of this is a medical team ordering overnight vital signs on a patient who has been in the hospital a long time. If the medical team is secure in their assessment of how well the patient is, they are fine to stop asking for overnight vital signs if the underlying concern, is that the family and the child haven't gotten enough sleep for weeks.

 

 

There are many fine gradations to your question which is certainly a good one. It's all part of what we do as a medical team.

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I've occasionally asked myself a variation of this question. What would I do if I were married to someone who refused what I consider routine medical treatment?

 

Probably this all depends on your fear levels and anxiety about treatment. Some people delay and avoid treatment not because they are afraid of a surgery ... but because they are afraid of facing up to a particular diagnosis.

 

I'm kinda weird, I guess. My father was in the field of medical research and knew a lot of doctors ... was good at selecting really skilled doctors ... and if a doctor he trusted strongly recommended a treatment, he went along with it.

 

But my dad is an outlier ... True story: my dad once had some prostate-caused pain ... and blockage ... He called his doctor on the doctor's day off ... and the guy came in and did a procedure on my dad WITHOUT anesthesia. And my dad only mildly complained. For my dad, it didn't matter if the procedure was uncomfortable--if he concluded it was in the best interest of his health, he scheduled it. He came home that day ... pretty much relieved to have the pain gone and blockage cleared.

 

Funny, maybe because my dad was in the medical field, I tend to like doctors and feel I can relate t othem. I make sure to find doctors I REALLY like.

 

Anyway my biggest fear is dying of something that was easily treatable. My second biggest fear: having a condition that was treatable that impaired my life ... and then I discover I could have treated it.

 

I'm actually having surgery in two days ... and I pulled the trigger on the decision much earlier than a lot of people. I researched the heck out of surgeons before I found one I really liked. So I divert my anxiety about my conditions into researching great doctors and various treatment techniques.

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