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?”
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.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.