"Losing sight of the forest for the trees" applies to many aspects of life.  Practitioners of medicine are not immune to this affliction of shortsightedness, as the following cautionary tale illustrates.

Some time ago I was asked by a urologist colleague to place percutaneous nephrostomy tubes and possible ureteral stents in an elderly Japanese woman with inoperable pelvic malignancy, ureteral obstruction, and uremia.  He had been consulted to relieve her ureteral obstruction and had attempted, without success, to place ureteral stents transcystoscopically. 

When I inquired as to whether further treatment options had been discussed with the patient, he assured me an oncologist planned to administer chemotherapy once her renal function improved.

I visited the patient.  Both she and her husband were elderly, frail, exquisitely-polite, first generation Japanese who spoke virtually no English.  Their son, whom I summoned to translate, 
spoke fluent Japanese and somewhat halting English.  I deemed communication to be adequate.  I did not revisit the issue of chemotherapy, but, rather, concentrated on a description of the 
procedure I was asked to perform, along with its attendant risks.

The procedure, while technically demanding and lengthy, was successful.  I was able to place percutaneous bilateral ureteral stents and nephrostomy catheters.   Initial hematuria cleared with time and the patient's flank pain gradually abated.  Her azotemia improved and she appeared to feel better.  Both she and her husband smiled as I made my daily rounds.

As is customary, once I ascertained her ureteral stents were functioning properly, I removed the nephrostomy tubes to minimize the risk of infection and to augment comfort.  My job completed, I ceased visitation.

Some time later, I encountered the urologist and inquired about the patient.  He indicated there had been a delay in obtaining approval for a formal oncology consultation.  Once treatment options were fully discussed, the family opted against chemotherapy.

"Oh," I thought.  "At least we helped her, albeit temporarily, by relieving her uremia."

Aloud, I said, "The stents are still working, aren't they?"

He flashed a sheepish grin.  "I took them out," he said.

"What?" I almost shouted. "Why?"

"After everything was discussed with the patient and her family,they decided they didn't want her to go home with tubes in her.  So I cystoscoped her and removed them."

The hours I had spent performing the procedure and in followup, the not-inconsequential radiation she and I had both received during fluoroscopy, the pain and discomfort she had endured, the many thousands of dollars in expenses incurred during close to two weeks 
in the hospital - it was all for naught, and could have been avoided had someone with a global medical outlook fully communicated various treatment options before hasty decisions were made to address consequences (in this instance, uremia) of a disease, rather than the disease (inoperable pelvic malignancy) itself.

While I may not be that ideal "someone," I have tried, since that event, to more carefully ensure that a given patient understands the ramifications of a decision to proceed with a diagnostic or therapeutic procedure which may be the first step down a path he/she may ultimately not wish to take.

Respect for patient choice necessarily takes precedence over what we health care providers may deem advisable.  Once in a while we are wrong.  Even when we are not, we must allow our patients, not unlike our children, to make their own decisions about life.