The answer seems kind of obvious, right? If you shoot first and it’s fatal, you won’t be able ask questions later. The idiom itself is extremely reactionary. My interpretation is that someone who shoots first and asks questions later is likely reacting to an intense fear of a perceived imposing, immediate threat. Certainly there may be circumstances in life when shooting first is the best option and I’ll let you, the reader, determine what they may be for yourself. Where I strongly believe “shooting first” is NOT the best option – actually, for me, it is never an option – is in making healthcare decisions.
While reading my digital New York Times this morning, I came across an article on dialysis later in life. Embedded in that article is a link to a comprehensive online resource which provides lists of five (or more) things that physicians and patients can use to spark conversation, to help inform of risks and benefits, and to make “right” decisions based on individual circumstances. The resource was created by the American Board of Internal Medicine Foundation (and their partners) and they aptly titled their initiative Choosing Wisely®. From the Choosing Wisely® website:
Choosing Wisely® aims to promote conversations between providers and patients by helping patients choose care that is:
• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary
The advance care planning geek in me is ecstatic to have found this resource! I plan to download the entire collection of PDFs for use with Caring Choices clients. I encourage you to share this site with people you love and your healthcare team for better informed, shared decision making.
We need to be asking questions before “shooting” into tests, treatments and procedures. Asking questions first doesn’t mean that we won’t go ahead with a test, treatment, or procedure. But it does mean that we are making informed decisions based on valid information, examining our situation and our wishes; not simply proceeding because the test/treatment/procedure is available. Some basic questions to ask might be:
- Is it necessary?
- How will it help me?
- How will it hurt me?
- How will it impact my quality of life?
- How much time do I have to make a decision?
- What evidence does research provide about it?
Shooting first and asking questions later is a gut reaction. In healthcare options and decisions, we need to be consulting more than our gut. As individuals, we are the only one going through the physical act of a test, treatment or procedure. However, we are encumbering those we love with the emotional and psychological outcomes of the test, treatment and procedure. These outcomes may involve complex and complicated caregiving, especially in later years. It will be important to know the how-what-why-when-where of caregiving needs when making decisions. Get informed about tests, treatments and procedures. Then, choose wisely.
Caring Choices understands that time can be of the essence when needing to make healthcare decisions. We know that there are times when following our gut makes sense. We also know that sharing conversations about healthcare options and decisions provides a sense of security even if we don’t all agree on the course of action. Making your decisions known to your loved ones and healthcare team will prevent them from the reactionary shooting first and hoping to be able to ask questions later.