I have been a conservative medical practitioner since my training days decades ago. As readers of this blog have read (?endured) repeatedly, I am very hostile to over-diagnosis and overtreatment. While I don’t have data, my strong sense is that I order fewer scans, offer fewer prescriptions and order fewer lab studies than my peers. I am not suggesting that my approach is the optimal pathway to medical quality, only that it has always defined my medical comfort zone. My philosophy can be summarized as less is more.
Patients have their own medical philosophies and over time
tend to link up with medical professionals who share their approach. Some patients laud physicians who test them
liberally regarding these doctors to be very thorough and conscientious. “My doctor is so thorough, on my first visit
he ordered blood work, a CAT scan and is sending me to 2 specialists!” Patients who prefer a more measured and
conservative approach seek likeminded doctors.
When the patient and the doctor are philosophically out of sync, it can
be challenging to forge a productive doctor-patient relationship.
For example, if a patient has received antibiotics several
times in past years for symptoms attributed to diverticulitis, how will he feel
when a new doctor is skeptical of this diagnosis and declines to prescribe
anything? The conversation is a veritable
minefield that can have lasting negative impact on the doctor- patient relationship.
Are you telling me, doctor, that my last doctor has misdiagnosed
me these past 10 years?
Every time my diverticulitis flared in the past, my doctor
gave me antibiotics right away and I always recovered.
With all respect, doctor, this is my body and I want the
antibiotics. If you won’t prescribe them
for me, then I’ll find someone who will.
Of course, I see patients every day who may not necessarily
embrace my conservative approach with respect to diagnosis and treatment. That’s
okay. As with every successful
relationship, there is dialogue, open mindedness, mutual respect and compromise. But all of us have boundaries that we will not
cross. In a relationship,
neither side holds sole authority. The
patient’s right to accept or refuse medical advice is a bedrock medical ethical
principle. But the physician has
professional and ethical responsibilities not to encourage or facilitate futile
care that offers no promise of benefit, consumes resources and erodes the integrity
of the profession.
If the doctor-patient relationship is sturdy, then the likelihood
of your receiving better medical advice and outcomes is increased. Shouldn’t this be the goal?
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