Physicians now practice in the
era of patient autonomy. Most agree that
the era of medical paternalism should not be resurrected. During those days, doctors simply told
patients what to do, and patients complied.
The informed consent process then was a shadow of what it should have
been. In general, physicians did not
proffer medical options and alternatives for patients to ponder over. They were told, ‘you need a hysterectomy’.
Sometimes, I think we physicians
today have over-corrected for past arrogance.
Yes, I believe in informing patients, but I often wonder if many
patients today really only want us to tell them which path they should pursue. Even the most informed patients are not
medical professionals who can grasp every medical nuance or ramification of a
decision. It can be vexing for them to
choose among different medical options that are presented to them in an effort
to meet our obligation to apprise patients of all reasonable treatment
alternatives.
Consider this scenario.
"You can proceed with surgery to
treat your condition or try a new medication instead. The medication has risks
and if doesn’t work, you can certainly have surgery. Keep in mind that if surgery is delayed while
you are trying the medication, it is less likely to be effective. Additionally, the medical center downtown is doing
experimental treatment for your condition. Finally, some experts advise against any treatment, advocating watchful waiting instead. What is your decision?"
Not an easy labyrinth for a normal
patient to navigate through.
Such a presentation is often
followed by a patient asking, ‘what do you think I should do?’
What should I do?
I’m not advocating depriving
patients of information they are entitled to in order to make rational health
decisions. I believe in informed consent
and have written many essays supporting it on this blog and elsewhere. However, I often believe that this process
overwhelms patients and their families with competing choices that torture and confuse them. As a statement of fact, many
patients today are only seeking our best recommendation, even though physicians
today go much further in an effort to meet our ethical obligation and to protect against a medical malpractice charge.
I am very interested in what
readers think on this issue. Inform me,
please.
My first thought is that you have neglected to describe a range of patients from those who want to be told what to do to those who know more about their condition than the person treating them. The vaunted patient-centered care encourages autonomy in the former and accepts it in the latter.
ReplyDeleteThanks, Ray. I confess that I am not in complete command of your point. I think that in our zeal to inform patients fully, that we often over-inform and overwhelm many of them. Our we serving these patients when by meeting our ethical obligation to inform that we are bewildering them?
ReplyDeleteAssessing the patients level of current medical knowledge should be important and also their desire to know all the options.
ReplyDelete