Decision Making

flowers-164754_1280Decision making is about pros and cons.    I was on my way to Boston Logan, to catch my flight to Bangalore.  My cofounder called me, and said “it’s a Navya moment.”    There was a personal, family, decision that he was helping coordinate, while he was at the Maui airport to fly across the country to get to his family in New York City.   Between our flight schedules and travel times, we had about an hour or so to chat before certain important decision had to be made.   The clock was literally ticking, and we started our process.   He had looked up the papers that discussed clinical trials and retrospective analysis of individuals in similar circumstances as his kin.  (He will write about these experiences in a blog post, soon.)  The advantage of waiting versus proceeding with a surgery was about five days at most.   That, was the known.  The evidence.  That we could likely delay surgery by five days and gain the benefit that would bring.  However, the disadvantage, the unknown, the risk of any complication while waiting, far outweighed the known disadvantage (mandatory stay in a well-managed, top of the line, intensive care unit).   Then, the experts.    Experts known to us pointed to their experience of being able to manage any complexity of surgery at the time.   They were comfortable, confident, yet let us (the patient and the family) decide.  What did the patient want?  There was anxiety.  There was anxiety about the known and the unknown – what was worse?  What did she prefer?  Patient preference.  And then, the much talked about guidelines – the international guidelines that indicated that both, surgery and non-surgery were acceptable options at this time.  Brilliant!  Not helpful.   It was a Navya moment.  We had to reconcile, hold each other’s hands, and decide from the patient’s perspective.

There are many elements to decision making.  Evidence, experience, experts, and patient preference being the most measurable, computable, elements.  Guidelines of course are the most general and are the weakest link.   At the center though, is the process of utilizing and combining all of the above.  The Navya process, which is extendable from oncology to obstetrics decision making.   The gentle consideration, the conversations, the repeated conversations on the various considerations, the data, the people, the process.  Always results in a decision that is well thought out, bringing clarity, and rooted in the best evidence and experience of experts.   The Navya process that we followed in an hour long conversation lead to two beautiful outcomes, a pair of healthy baby twins, born at the right time to a mother who felt relieved with confidence in her decision. 

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