Why Ethics Matters to You

A Primitive Advance Medical Directive (before surgery)

Do you believe that medical ethics is an area of philosophy that doesn’t apply to you?

Many share that misconception. The principles of bioethics – autonomy, confidentiality, beneficence and non-maleficence – certainly sound like high level philosophical concepts. No wonder people assume that they’re not relevant to their everyday lives.

In reality, ethics is at the core of your relationship with doctors and other healthcare providers. Although we seek to help our patients (the principle of beneficence), this must be balanced with the risk of doing harm. Every treatment, medication and test carries potential risks, including side effects and complications. For this reason, the first rule of medicine is to do no harm (non-maleficence).

Tests and treatments, including medications and procedures are merely the tools of medicine; ethics guides us in their use.

In the practice of medicine, we have evidence-based protocols and guidelines on the best treatment of specific medical conditions, such as an acute stroke or heart attack. They are continually being updated based on clinical research. However, the treatment that individual patients would choose for themselves may not be what the guidelines recommend.

In healthcare, we do not treat medical conditions in isolation; we treat the whole person in the context of a unique life. Individual autonomy (the ability to make one’s own choices) is a fundamental guiding principle.

For example, if a previously capable adult was unconscious after suffering life-threatening blood loss in an automobile accident, the emergency doctor may recommend a blood transfusion to save his life. However, if that patient when capable left clear written instructions that he would not accept a blood transfusion under any circumstances, his wishes would be respected by the physician even if family members want him to receive the blood.

During the time that Burnaby Hospital had its own Ethical Resources Committee, I was the chair for 17 years; in my last 10 years in that role, I led a team providing ethics consultations at the request of families, patients and healthcare providers when they couldn’t agree on the best course of action.

Many of the patients we were asked to see were in the intensive care unit or in long-term care, where it wasn’t clear if life support such as machine-assisted breathing, feeding tubes and IV fluids would provide benefit to the patient. In all cases, the patients were unconscious or for other reasons no longer capable of understanding their situation, making medical decisions and communicating their preferences to the care team. In none of the cases had the patients put anything in writing in the past when they were capable of giving consent.

Family members would then have to make heart-wrenching decisions on behalf of the patient based on what they thought their loved one would want. Dilemmas arose when family members disagreed with one another or with members of the hospital care team.

Sometimes, it wasn’t clear which family member was the most appropriate decision maker on behalf of the unconscious or otherwise incapable patient.

If you were the patient, who would you choose to make decisions on your behalf? Would they respect your values and all that gives your life meaning?

Who has the right to see your medical records? Under what circumstances may you lose the right to make your own decisions? How do you make your wishes known in advance?

I will address these questions in upcoming columns and at 7 pm on Tuesday, April 7^th at the Bonsor Recreation Complex. I’ll be speaking on a topic relevant to your care both in and out of the hospital, “What You Should Know About Medical Ethics.”

This free public talk is part of the Burnaby Division of Family Practice’s Empowering Patients education series For more information, call Leona Cullen at (604) 259-4450 or register online at lcullen@divisionsbc.ca.

Dr. Davidicus Wong is a family physician. For more information on the Burnaby Division of Family Practice’s public health education series, check our website at divisionsbc.ca/burnaby. davidicuswong.wordpress.com.

#38 Where is the Happiest Place on Earth?

One of our favourite family vacation destinations has been Disneyland, the happiest place on earth. I’ve told my kids to notice the transformation in the families around us as we walked through the gates and entered the Magic Kingdom.

Of course, they noticed that a lot of kids were still crying, some teens still looked bored and grown-ups were still arguing just as they had been a moment ago.

But as a family we were determined to have fun and make the most of each day together – even after we left the park.

The lesson to my kids was to ask themselves, “If I can’t be happy in the happiest place on earth, where can I find happiness?”

Since they were toddlers, I’ve been teaching my kids to appreciate the people in their lives, enjoy the joys of the present, and to seize each day. They have taught me the same things.

Happiness is not found in a place far away, in the past or in the future, and it we won’t find lasting happiness if we are always looking outside of ourselves.

Happiness is part of the art of living. It requires an attitude: an intention to be as happy as you can be, to appreciate what you’ve been given, to accept the challenges before you and to enjoy what you have today.

Happiness requires action. Sometimes the best in life can come to you out of luck and grace, but you can miss out on your potential for happiness by not doing what you love to do.

We each have a calling – what we were meant to do in this life. It’s your personal gift to the world. Don’t let everyone down, and don’t disappoint yourself.

Happiness requires living fully: living in the present, living mindfully, living graciously and living for something greater than yourself.

Your happiness exercise for today: Think about your home, school or workplace. What can you do or change through your own attitude and actions to make each of them the happiest place on earth for yourself and everyone else?

Tomorrow, ask your family, your partner, your friends, coworkers and classmates, what you can do together to create the happiest place on earth right here and right now.

A Hundred Days to Happiness #37: Reviewing your week

Most of us celebrate Friday because it brings a welcomed break from the work of the week. After my son moved to his campus dorm for his first year at UBC, I looked forward to seeing him back home on the weekends.

So after I was finished at the office one Friday, I drove out to campus to watch him play rugby in a steady downpour. When he was the infant I rocked to sleep in my arms or the toddler I would catch at the bottom of the slide, I would never have imagined that he would go on to play rep hockey, high school football and now the roughest game of all.

After the game, we had a chance to review the week. I asked about the highlights of his week and what he had been working on in his classes and labs, and I told him of some of the funny things I experienced during my week.

Weekends can be a wonderful time to touch bases and reconnect with your family and friends. Kids and adults can get so wrapped up in their own activities during the week that they may not take the time to reflect personally and together.

Your happiness exercise: Reflecting on your past week, ask yourself the questions I asked my son. Did you have fun this week? What were the highlights? What’s been occupying most of your time? What challenges have you had? What did you learn?

Weekend reviews can bring closure to your week. With reflection, you can tell if you’ve been on track doing the things that matter most to you or if you’ve been distracted with the busyness of your life.

We can see how we can grow week by week and day by day. As you begin a new week, make it a priority each day to do things that bring you happiness.

make it a priority to do things each day that bring you happiness.

What to pack . . . for your hospital stay

In my last column, I wrote of the inevitability of you landing in the strange place we call Hospitaland and the curious customs of its inhabitants. To prepare you for a potentially unexpected visit and to reduce the chance of a misadventure, I’ll review the essential things you should pack.

Without being anxious or fatalistic, we have to expect that anything can happen anytime. It helps us not to take health, life and loved ones for granted, but rather to appreciate what we have when we have it. We can also be prepared.

My parents ingrained in us good hygiene that included daily bathing and clean socks and underwear. I’m glad they didn’t give us the traditional rationale that “we should wear clean underwear every day in case we’re in an accident.”

That never made sense to me. If you were surprised by a bad accident, would you have the composure not to poop or pee in your pants?

Better advice would be, “Never miss an opportunity to use a toilet.”

And I suggest that you neither wear or pack your best Victoria Secret lingerie or Calvin Klein underwear. They are likely to be cut away with utility scissors for emergency procedures. The same goes for your favourite Superman or Sponge Bob undershirt.

If you’re planning to be admitted for an elective procedure, consider using a Sharpie felt pen on yourself to leave advanced directives when you are unconscious in the OR. “Not this leg, the other one.” “I’m here for my gall bladder not a hysterectomy (or a vasectomy).” “I signed up for a left hernia not a bilateral orchidectomy (castration).”

Your “travel documents” are essential. I don’t mean your passport and boarding pass but rather the essential information that another doctor will need to give you the best care. This includes a one-page summary of your medical history, including allergies, previous operations and hospitalizations, family history, and both chronic and past illnesses.

If you don’t have this information at your fingertips, you’re family doctor will be able to provide this to you. Look into this now, rather than waiting until you urgently need it.

You should also carry a complete list of any medication you are taking, including nonprescription vitamins or drugs. This should include a prescription drug’s brand name and generic (or chemical) name, dosage (i.e. in mg) and directions (i.e. twice daily).

Another essential document is an advanced medical directive, that some call a living will. This states what you would or would not like done to your body should you not be able to make medical decisions at the time. For example, if you had a stroke and couldn’t speak, would you want to have CPR (chest compressions and assisted breathing)? Would you want IV fluids? Tube feeding if you couldn’t swallow? Machines to assist breathing? Blood tranfusions?

Sorry you don’t get to choose the colour of your hospital gown.

You should also indicate whom you would want to make decisions on your behalf. This should be someone you trust to respect your wishes. Talk to this person ahead of time so that your values and preferences are known.

What you should not bring with you to the hospital are things that could be lost or stolen. This includes valuable watches, jewelry, smartphones, electronics, credit cards and money. Your old cassette or CD player is okay.

Because you don’t have a choice of roommates, room temperature or lighting, bring earplugs, headphones, an eye mask for sleeping, warm socks, a supply of clean underwear, a sweater and an extra blanket.

Of course, as with any other trip, bring your toothbrush and toothpaste but don’t bother with makeup (even if your nurses or doctors are really good looking). Definitively, do not wear any cologne or perfume that may be harmful to other patients with allergies or respiratory problems.

Bring something to keep you occupied when you are lying or sitting around for hours at a time: puzzle books, magazines and books. Always have a pad of paper and a pen. This is helpful for you to take notes of what your healthcare providers discuss with you and to write down messages or questions for your attending physician. If healthcare providers use unfamiliar medical words, ask for clarification and have them write things out for you. In the case of doctors, ask them to print.

On Friday, March 27^th at 7 pm, I’ll be speaking on “How to Survive Your Hospital Stay” at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the McGill Public Library and Eileen Daily Pool). I’ll tell you everything you need to know to have the healthiest, least eventful hospital stay possible. On April 7^th, I’ll be speaking at the Bonsor Recreation Complex on a topic relevant to your healthcare both in and out of the hospital, “What You Should Know About Medical Ethics.” How can you ensure your wishes are respected? What is the essential information you need to make informed decisions? Who is looking at your medical records?

These free public talks are part of the Burnaby Division of Family Practice’s Empowering Patients education series For more information, call Leona Cullen at (604) 259-4450 or register online at lcullen@divisionsbc.ca.

Dr. Davidicus Wong is a family physician. For more information on the Burnaby Division of Family Practice’s public health education series, check our website at divisionsbc.ca/burnaby. 

Are you prepared for a visit to the hospital?

The odds are in favour you’ll one day find yourself in a hospital, and the older you get, the greater the odds that you will. You might as well pack your bag today because being a patient is a lot like taking a trip to a very foreign country.

If I were to write a guidebook for hospital patients, I’d call it “The Lonely Patient’s Guide to Hospitaland.”

The inhabitants dress differently – usually in greens and white coats, and it’s hard to tell who’s who.

Doctors wear nametags with their first and last names. Almost all the rest of the staff shows only first names. You however have to wear a wrist band with your full name, birth date, PHN and the name of some doctor you may not recall meeting.

If you have allergies, you earn an extra brightly coloured wristband, but don’t mistake this for an all-inclusive resort. The closest thing you’ll get to a massage might be a sponge bath.

In the summer time if your semiprivate room is too hot, you might hallucinate that you are in a sauna since you and the other guests are all nearly naked beneath your very thin hospital gowns.

And like the pool deck, you’ll see more than you wish of the scantily clad guest strolling by where gowns don’t quite cover up.

While you’ve heard that in some countries a five star resort is really four stars in quality, when you start complaining that the food is only two stars, doctors take this as a sign that you’re getting better or at least nearly normal and ready for discharge.

The inhabitants of Hospitaland speak a different language. Instead of “aloha”, we have other multipurpose, ill-defined words like “rounds.” When a doctor visits patients at the bedside, we call this doing rounds. When a bunch of doctors gather to talk about one patient, we call that department rounds. When doctors gather for group education, it’s called grand rounds. When doctors and nurses meet to talk about the patients on the ward, we call it team rounds. When I can’t find anyone to help me read a CT scan, all the radiologists are on brown rounds (that is a coffee break).

They also speak in CODE. Code Blue is a cardiac or respiratory arrest. Code Pink is a maternity emergency. Code White is a psychiatric emergency. Code Yellow is pee on the floor and a potential WorkSafe hazard. Every hospital has its own code.

The inhabitants have odd customs. Everyone who talks to you will write in a big binder with your name on it, but don’t dare try to look into that binder yourself. A stern and scary nurse will tell you that you are not allowed to do this without medical supervision – unless you care to fill out a bit of paperwork and wait (until you are discharged from the hospital). If you hadn’t been diagnosed with paranoia on admission, you might be before discharge (but don’t take my word for it. Just try to look in that binder).

On Friday, March 27^th at 7 pm, I’ll be speaking on “How to Survive Your Hospital Stay” at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the McGill Public Library and Eileen Daily Pool). This free public talk is part of the Burnaby Division of Family Practice’s Empowering Patients education series. I’ll tell you everything you need to know to have the healthiest, least eventful hospital stay possible. For more information, call Leona Cullen at (604) 259-4450 or register online at lcullen@divisionsbc.ca. In my next column, I’ll tell you what to pack for your inevitable trip to Hospitaland.

Dr. Davidicus Wong is a family physician. For more information on the Burnaby Division of Family Practice’s public health education series, check our website at divisionsbc.ca/burnaby.  

#36 The ABCs of Health and Happiness

The ABCs of Health and Happiness Davidicus Wong

Accept responsibility for your own health. Be active. Create happiness for yourself and others. Don’t drink to excess. Eat a healthy diet. Follow your bliss. Greet each day with gratitude. Help yourself to happiness by helping others. Identify your strengths. Jump at every opportunity to make someone else’s day. Kickstart each day by counting your blessings. Love unconditionally; we are all human and worthy of being loved. Mind your thoughts; they shape your moods. Nurture healthy relationships. Open your heart and mind. Project inner peace. Quit smoking. Respect your body. Smile and see the beauty in your world, in others and in yourself. Transform every problem into a positive goal. Understand that it takes a village to care for a village; everyone matters. Visualize your goals. When feeling rushed, wait for your mind and body to move together. Exude passion. Yield to your better and wiser self. Zestfully embrace this day.

#35 TEN THINGS YOU CAN DO FOR YOUR HEALTH

7 Mantras (Davidicus Wong)

10 THINGS YOU CAN DO FOR YOUR HEALTH by Davidicus Wong

1. Be active. Make physical activity part of each day.
2. Get a good night’s sleep.
3. Eat a variety of fruits and vegetables.
4. Avoid saturated and trans fats in butter, hard margarine, lard and shortening.
5. Limit salt and alcohol.
6. If you smoke, stop.
7. Let every strong emotion be your meditation gong, reminding you to ask, “What am I feeling, thinking, saying and doing?”
8. Choose your thoughts. Abandon thoughts that foster negative feelings and behaviour.
9. Actively manage stress. Accept what you cannot change; take responsibility for what you can.
10. Be kind to others and yourself.

#34 What’s on your list of favourite things to do?

In the final year of med school, some nights on call were hard to get through. As medical students commonly referred to as scut monkeys, we were at the bottom of the hospital totem pole.  Though we were there to learn and to care, we were an unpaid labour force assigned to the more onerous, time-consuming tasks. In the O.R., we could be holding retractors for hours without seeing much of what the surgeon and residents were doing. We would be the first to be paged to the E.R. for new hospital admissions or to the wards for distressed or confused patients.

To make it through those long nights, I would bring a list of my favourite things – what I looked forward to doing when I was no longer on call: licking a Dole Whip cone from the hospital cafeteria, riding my bike along the Stanley Park seawall or through the streets of North Burnaby, playing my parents’ piano, hanging out with my friends, having tea and chatting with my sister, going out with my girlfriend, enjoying dinner with Mom and Dad, or getting a full night’s sleep in my own bed.

This was no bucket list. None of these activities were really momentous or unusual, but they were related to comforting, enjoyable sensations and feelings. They reconnected me with life and the people I was closest to.

Now, each of my days is filled with meaningful work and experiences, and I feel connected to others and life virtually all of the time.

I still keep a list. When I’m feeling overwhelmed with the endless tasks associated with my work or the competing demands of my roles in life, I choose at least one of those simple joys.

Of course my list has changed. It includes going for a swim; calling my sister or dad; enjoying dinner with my family; reading a good book; writing, drawing or playing my piano, Skyping with friends, and just being around my wife and kids.

Your happiness exercise for today: Write your personal list of favourite activities. What can you do today to feel refreshed and reconnected to the people that matter most to you? What brings you joy? Do at least one of your favourite things today (and every day).

A Hundred Days to Happiness #33: Happiness is being in the presence of a child

Happiness is being in the presence of a child.

I loved the days that I got to drive my daughter to elementary school. I’d rush home from my morning swim to make her favourite breakfast and wake her up with a hug and kiss on the cheek.

Her smile still makes me smile.

My kids always had a way to bring me more fully into the present, and because of that, my memories – of days at the zoo, towing them in my bicycle trailer, teaching them to skate, to swim and ride without training wheels, pushing them on swings and catching them at the bottom of slides – remain vividly real to me.

These experiences in my children’s presence remain in my heart and remind me of the joy of living.

I loved chatting with my daughter en route to school. No matter what wisdom I tried to impart, she was always teaching me something new . . . or reminding me of something I once knew but had forgotten.

One morning, thinking of my busy day ahead, I said to her, “You’re so lucky to be a kid!”

“What do you mean?” she asked from the back seat. “You’re a grownup! You get to drive a car, and you can go wherever you want.”

I couldn’t help but smile and laugh. She was right again.

“You can eat whatever you want” she added, “and go shopping all by yourself.”

After I dropped her off, she thanked me and wished me a happy day. Knowing I could drive wherever I wanted, I chose to go to work anyway, and I did have a happy day!

Your happiness exercise: be in the presence of a child, be fully present and see your world from a child’s perspective.

#32 Happiness is being in the presence of friends

I could be totally healthy, physically fit, wealthy and successful, but if I did not have one true friend, I would not be happy.

My friends have helped me through the darkest times in my life – with illness and accidents, failures and breakups, tragedy and grief. No matter what life presents, my friends bring me hope and happiness.

We all mean different things when we call someone a friend just as we feel different things when we say, “I love you.”

Do you define friends as the people you like to hang out with? Your drinking buddies? Your shopping pals? Your partners in crime? Are friends the people you small talk with? Are they just people that are fun to have around?

Sometimes we have friends who justify our bad behaviour and bad habits. In their company, we may drink more and abuse our bodies more. These are our travelling companions on the road to self-destruction.

But I recognize true friends as people who are better together than apart. Real friends bring out the best in one another. We help each other achieve our potentials. We can do more together than we could alone.

My best friends know the real me. They sometimes see me better than I see myself. They recognize the best in me, remind me of my dreams and push me to be my best.  They recognize the worst in me, call me on it but love me nonetheless.

My best friends tell me the truth – even if I don’t want to hear it – because I need to know.

What best friends give is the purest form of love, and that love is omniconditional; at every stage in life, at any age and in every circumstance, we are loved, accepted and forgiven just as we are.

Love is the flower of friendship in full bloom; it never withers and never dies.

Happiness is being in the presence of a friend.