As I previously stated, my status said that until it was changed (out of my control—I can longer edit it, but someone wrote for me "non-medical"—it was previously more specific), and as you said yourself, I did state in this thread that I am not a doctor, as well. I can attempt to expound on that more in the future if this situation comes up again, but I rarely offer advice, and to the extent you think advice about holding a trip to Atlantic City as a bargaining chip over someone close to the OP based on whether they take a shower or not is a medical question when they are in denial about their health status, I think I offered enough advisement ("I am not a doctor" is pretty clear). Obviously the answer among the people who *are* self-identified as doctors in this thread varied greatly. To the extent this is a medical question, there is no clear medical answer (perhaps in large part because the question was presented without a lot of background information and relates more to palliative care than the care doctors directly provide).
It's often stated by various members in this forum that too many people try to label issues as psychiatric when they are not, especially as it relates to "bad behavior" and that the field of psychiatry becomes too ensnared in fixing society's ills when its original focus was meant to be more narrow.
I would argue that toward the end of a person's life, or really at any stage, but particularly at the end, issues like this will arise that are part of the human experience. And I am less inclined to see it as medical. I don't think you can medicalize every decision a person makes.
I would not assume the identity of anybody in an anonymous public forum, and I would hope that my medical care was not based on a doctor assuming that. If it gave someone an idea that they vetted with someone in real life or that was consistent with their own medical knowledge, that seems like a fine use. But I don't think anyone is realistically making treatment changes based solely on any individual post here, and if they are and something happened, it's still their responsibility. I don't assume or believe the OP is a doctor. And I don't think this was a peer to peer request; that's just my instinct.
For the me issue wasn't when you opined about end of life and showers, as certainly there can be a lay view on the topic of hygiene or priorities of energy expenditure. It was more when you were trying to elicit more detailed background medical information and especially when you started talking about medications and health conditions that I felt you did actually venture over into health advice. Honestly, it was enough that I had to doublecheck who was posting and that it was indeed you. If I wasn't familiar with you already I could easily see someone not catching you are not medical and thinking that maybe you were.
While I wouldn't expect a physician to have care meaningfully swayed by attention to an online forum without looking into the matter further (vetting the source or double checking the info with a better source), I don't know that I feel as confident saying that would be true for basically anyone else reading.
I don't say this to beat up on you, because I generally appreciate the additional perspective you bring to the forum, but because I was honestly a bit taken back by some of the posting. I think Mass Effect's criticism here has some merit and that's about it.
When I responded by the way, I purposefully didn't try to elicit more detailed medical history. Because I think it was important to demonstrate what the appropriate medical thought process is when faced with a question like this with so many unknowns. It's important to explain like, "here's what we don't know and why we can't advise in this situation this particular answer this person is looking for." The reason is because as providers we are frequently faced with this kind of thing. It's one thing for us to formalize an answer when we know particulars, and another thing when faced with the ambiguous.
And note that nothing we learned contradicted any of the points I made. That was intentional. We were asked for a stock answer and I gave one. Having more information didn't really change the assessment and just really ended up reinforcing the one I gave.
OTOH, digging in more led to a lot of stuff that got very specific about medications. This is frankly less ideal, because that is a little bit beside the point, and without a full chart review and patient exam getting more specific might be problematic. I am of the opinion this was best approached as a vague question and the right answer about hygeine for this unseen person is, "it greatly depends."
To be frank, you didn't seem to get that it was inappropriate to dig and try to be more specific in this case. No amount of chart info in this case can really let us advise specifically
- we haven't seen her skin, her bed sore, or assessed her mental status and level of physical strength, all of which are important for gauging her hygeine and ability to safely shower or bathe. I know others gave some very specific opinions about medications, but they also weren't the ones initially eliciting more specific info. I think it wasn't totally appropriate here to get into for this unseen patient.
I normally wouldn't have made a point of saying where I thought you went wrong, but since it's led to this conflict I thought I would add my two cents.
In any case it's a very important skill for a provider to explain to a lay person why they can't give a specific opinion in many cases. Many times formulating that answer is less straightforward than forming a complete medical opinion.
