Docs and Their Beliefs

Friday, February 9, 2007

It should come as no surprise that doctors have personal opinions and beliefs and that those beliefs color the advice given to their patients. So should we be shocked that a study published in the New England Journal of Medicine confirms that about 85% of physicians feel obligated to disclose all medical treatment options and only 70% would agree to refer patients to someone who does not object to a requested procedure?

There is also no surprise that the procedures in question were abortion, birth control prescriptions to minors without parental consent and terminal sedation or euthanasia. “This study suggests that the balance that most physicians strike between paternalism and autonomy involves both full disclosure and an open dialogue about the options at hand” (NEJM, Feb 8, 2007)

So where are the positive action, authority and autonomy that are required to be taken by the patient?
There is a want to have the doctor “take care of” the patient, who is allowed to assume a passive role in the relationship. Patients, though, have the ability to become aggressive consumers in other relationships. They love their car mechanics, know intimate details of their hair cutter and expect the barista to remember their routine order. But rarely does the patient decide to interview their physician. The relationship develops haphazardly and there is a fear that somehow, the doctor may be insulted if their judgment, decision making, demeanor or even the way the office is run is questioned.

The responsibility to make a physician-patient relationship work is two sided. The patient should learn the philosophical bent of their physician and decide whether the social values can mesh. Crisis is not the time to learn that a major disconnect exists in the relationship. Aside from providing medical care, the physician is charged with being the patient advocate, a role that is hard to play when the two parties don’t take the time to learn wants and needs.

The parable:

People spend a lot of time and money on their cars: oil changes, washing, searching for a good mechanic takes effort. But major repairs are expensive and people understand the need fro preventive maintenance. And every month people are reminded about how expensive a new car can be when the payment comes out of the chequing account.

On the other hand, we get our bodies for free and the maintenance can be painful or embarrassing: pelvic exams, pa smears and colonoscopies don’t rank high on the things to do list. And the routine yearly check up just doesn’t happen anymore. Too busy, too inconvenient and maybe too expensive (though a routine doctor’s office visit might run less than $100).

Those office visits are when you get to know your doc and they get to know you. When the big medical stuff happens to you or a loved one, when you need advice about end of life decisions or pain and suffering issues, where will you turn? The urgent care doc you saw once for a jammed thumb, the nurse in the pharmacy clinic for a sore throat?

It’s hard for patients to know if their physician is providing all the options available unless you know and trust your physician. The New England study reminds us that not only do you have to judge the information; you have to judge the source. That judgment shouldn’t need to happen in the heat of the moment.

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