Anxiety over mortality can cloud health-care decisions
We all like having options. We want to make our own decisions. We appreciate the idea of choosing from among a number of well-defined alternatives.
Most of the time.
When it comes to the really important decisions, we often can feel overwhelmed by the number, complexity, and importance of the choices available to us. This is especially true when it comes to physical health.
"I just don't know what to do." I hear this all the time from people faced with making decisions about their own or a family member's health care. Usually it's accompanied by a good deal of anxiety, frustration and even fear. And the more important the decision, the more powerful these emotions.
Most good health care professionals will be quick to admit that they can never be 100 percent sure about any diagnosis or treatment plan. In fact, sometimes they will share with us two or three possible explanations for our current malady with, perhaps, two or three courses of treatment for each.
And, more often than you'd expect, getting a second or third opinion will result in a significant difference in either diagnosis or treatment suggested.
The more complicated and, too often, more life-threatening our physical complaint is, the more this seems to be the case. It seems like it's at the times we are the most emotionally off balance that we are faced with a health-care decision that requires us to be cool, calm and rational.
This is not the fault of the health-care community. One thing I learned a number of years ago when I had the chance to work as part of a treatment team with doctors and nurses is that a lot of health care is guesswork - educated guesswork, usually accurate guesswork, but guesswork nonetheless.
There is an awful lot we don't know. And what we do know we shouldn't be too sure about. Physical health is an incredibly complicated area involving biology, physiology, psychology, sociology and spirituality. Throw in things like genetics, environmental factors and human development, and it's not hard to understand why even the most expert health care professionals are reticent to make hard and fast judgments or recommendations about whatever has led us to consult them.
This is not even a dilemma we can blame on managed care. If anything, managed care companies are dedicated to reducing the number of options we have (though often to the ones that cost less, not necessarily work best).
I'm afraid what we are really dealing with is something we don't like to talk about. It has to do with the uncertainty of life, its inevitable end, and our ultimate powerlessness to reduce this uncertainty or postpone this ending.
The technical term for all this is "existential anxiety." What that means in real words is that everybody is afraid of illness, disability and death - our own, or of the people we care about.
We don't have the space here to go into an exploration of this anxiety. It is worth exploring, though, perhaps with our family, friends or spiritual director. Deciding what life is all about may be the most important health-care decision we ever make.
What I do want to suggest here is that, as we deal with the often emotionally wrenching experience of making decisions about our own and others' health care, we realize that only part of our response has to do with the uncertainty and complexity of our choices.
Underlying these emotions, we also are dealing with the certain, simple and unavoidable reality that our physical health, and ultimately our existence, is not a perpetually renewable state. That reality, perhaps, warrants a bit of anxiety.
• Dr. Ken Potts is on the staff of Samaritan Counseling Center in Naperville and Downers Grove. He is the author of "Mix Don't Blend, A Guide to Dating, Engagement and Remarriage With Children."