Patient Decision Making and the Acute Stress Reaction: What does the hair specialst need to know?

Decision Making by Patients is Impaired During the Acute Stress Reaction:

The practice of medicine is different nowadays. We advise patients on their options and help them figure out what’s best for them. Physicians no longer tell patients to “do this or that.” 

The old saying “take 2 aspirins and call me in the morning” no longer applies. Nowadays, we say something closer to “you might consider taking 1 or 2 aspirins if you are comfortable with the side effects we reviewed together or you might consider pursuing one or more of the other options we discussed.”

There is one important exception - and that is the acutely frightened, scared and terrified patient who has what we can an “acute stress reaction (ASR).” An example a patient experiencing an ASR is a patient with rapid hair loss. Many such patients have lost the ability to think clearly due to fear. These patients need more guidance than simply leaving all decisions up to them. Asking the patient “what do you think?” about certain recommendations the hair specialist gives has many challenges when the person sitting across from them cannot think clearly due to fear.

Medical research has focused on how people make decisions under stress. We don't talk about it all that much but evidence is pretty clear - many of us don't make good decisions under stress. We make mistakes. We buy things our non stressed self would not buy. We don't buy things that our non stressed self would buy. We say things our non stressed self would not say. We don't say things that our non stressed self would shout out. Stress hormones and other neurotransmitters affect how the brain makes decisions. Elegant animal studies back up this simple concept. When we are stressed we behave differently and make decisions that we otherwise would not make.

The entire issue is open to lengthy and complex discussions about ethics and informed consent. Is the acute stressed patient really making informed consent? Many patients suffering acute stress reactions (ASR) are left to figure things out on their own and some are taken advantage of by aggressive marketing. Many patients experiencing ASR’s will choose any option that they are presented. Internet marketing has preyed on many of my own patients experiencing ASRs.

In my view, there are times when we need to hold on to the steering wheel of the driver and there are times when we can offer suggestions from the passenger seat. We need to help our patients in the same manner that we someday would want to be helped when put in a similar situation. We need to help our patients who are experiencing ASR's to make decisions that really reflect what their non stressed self would make. It's certainly not easy but it certainly is how things should be done.