Our favorite Dinosaur has an important post – The Dirty Little Secret About Patients as Partners in Health Care
Despite the abundance of information on the internet, the practice of medicine is more than just the application of an abundance of information. Above and beyond the knowledge conveyed during medical school (half of which is wrong, although no one knows which half) and the experience gained during residency training is the years of day-to-day exposure to that medical knowledge and training experience in real live people — the practice of medicine.
This is why no amount of information — whether obtained from me, the internet, or even those really cool collections of pieces of dead trees called “books” — will ever properly equip a patient to make an actual medical decision. The dirty little secret is that in the final analysis, it will always be doctors who ultimately make decisions about medical treatment.
She is spot on. I often give patients choices. I try to provide them unbiased information to make those choices. However, I know that I cannot present in an unbiased fashion, and I do not think that anyone can.
Usually I just order tests or medications without consulting patients. Most patients do not expect to choose tests or treatments. When they demand tests, I still may not order them if I believe that the test is not indicated. When they demand medications, I still may not order them if I believe the medications is not indicated.
We have a responsibility to discuss treatment philosophy with patients. We need to understand their goals of therapy. But we cannot, and should not allow patients complete autonomy. We must make most medical choices for patients.
We do have a responsibility to explain our decisions to the patients, and to elicit their input and consent. But I must choose the antibiotic, or the next antihypertensive drug, or whether or not to start a statin. I should educate the patient, and I should clearly explain my rationale.
H/T to Dinosaur for addressing this issue.
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I don’t expect my doctors to consult me, but I do expect them to explain what’s going on.
When my doctor prescribed a new medication, I appreciated him telling me about the med, including the fact that it’s a beta blocker. Since it’s my health on the line, I thought it worth asking about the fact that beta blockers are contraindicated for people with Raynauds. If he’d considered that and still thought this was the best med to try, I would. But if he forgot that little piece of info and wanted to try a different med, it could make a huge difference in my well being.
So I appreciate getting information, and I appreciate my doctors being willing to listen. Sometimes patients do know something that impacts treatment decisions.