A case that I found very challenging as a medical professional was a post-bariatric patient with type 2 diabetes experiencing protein malnutrition, which was occurring despite adherence to a standard dietary regimen. Her blood work indicated plummeting levels of albumin, and she was wasting lean muscle mass at an alarming rate -- but she was adamant she could not drink protein shakes or eat meat. Ultimately though, I made the very difficult decision to put her weight loss goals on hold temporarily in order to focus exclusively on protein repletion, even though that meant putting her progress on hold. What convinced me was the research that demonstrated that protein malnourished state in bariatric patients increases complication rates 300% (Journal of Gastrointestinal Surgery) along with her continual decline in lab values. Our half-portion formula of plant-based protein pudding and increasing the frequency at which we took our protein (was taking 500-750 calories worth every 5-8 hours, now every 2 hours) so our body could absorb nutrients. What mattered in this decision were metabolic data over scale numbers (her pre-op body scans showed dangerously low muscle reserves) -- and her psychological resistance to traditional options. At Ambari Nutrition, we built out our 'Tiered Protein Tolerance Protocol' based on this case; 120+ bariatric centers use it today. Now, we customize her liquid/soft foods from our medical line specifically tailoring her protein at 80g/day -- 6 months later and she is finally safe to lose weight again. This underscored for me that sometimes the correct clinical decision is counterintuitive to the patient expectations, but we must always prioritize the preservation of fundamental health parameters.
Certainly, dealing with challenging clinical decisions is a huge part of working in healthcare. I recall a situation where I was overseeing the care of an elderly patient with advanced dementia and multiple chronic conditions. The patient developed pneumonia and was deteriorating despite conventional treatments. One of the significant decisions was whether to escalate the care to intensive treatment or prioritize comfort measures. The factors influencing the decision included the patient's pre-existing health status, their overall quality of life, and discussions with their family regarding previously expressed wishes about end-of-life care. Ultimately, after thorough discussions with the family and consultations with my healthcare team, we decided to focus on palliative care. This decision was guided by our understanding of what would offer the patient the most dignity and the least suffering during their final days. Recognizing the values and preferences of a patient, even when they can no longer communicate those themselves, is crucial in providing compassionate care. In such instances, it’s heartening to know that prioritizing comfort can be the kindest form of medicine.
As the founder of media and marketing companies, I don't make clinical decisions. My tough calls involve clients. For instance, a women's fashion retail client wanted a controversial marketing campaign. Factors like brand image, potential backlash, and consumer perception influenced my decision to suggest a more balanced approach. I believe in pushing boundaries, but also in maintaining respect and understanding for our audience.