Tuesday, February 07, 2012

How patients think

I have always been fascinated by why different patients make completely different kind of decisions , when faced with exactly the same problem. Thus , there will be patients who will happily resort to IVF when they have a fertility problem ; land on the other hand, there will be those who will spend 10 years taking homeopathic medicines in order to improve their fertility . I just read this great book, called, Your Medical Mind , by Dr Jerome Groopman . He's the author of the book , How Doctors Think - and I think a better title for this book would have been - How Patients Think .

In today's world , there's a lot of emphasis on what is called evidence-based medicine . Administrators are trying to force doctors into straitjackets and want to ensure that doctors blindly follow standard algorithms and protocols . Doctors are being forced to function as assembly line technicians , so that the care which they provide is no longer patient centered care, but system centered care. Unfortunately , bureaucrats don't realize that evidence-based medicine is really not the solution. What we need to practice is judgment-based medicine , where doctors can use their judgment to make the right decision for their patient.

The reason the mindless application of guidelines causes so much angst to doctors ( and distress to patients) is that they do not take into the account the patient's personal preferences and opinions about the various treatment options . The great thing about this book is it provides a lot of clarity as to how we can systematically factor in the patient's worldview , so that we can make individualised decisions which are right for each patient.

Doctor Groopman believes there are three important variables which impact a patient's medical mindset or worldview. All patients need to figure out for themselves where they stand.

First, there are patients who are technologically oriented , as contrasted to those who are naturally oriented . The ones with a naturalism orientation will use natural healing techniques and alternative medicine ; whereas those who have a technology orientation prefer using the procedures with high-tech Western medicine offers.

Secondly, there are maximalists versus minimalists . Maximalists are those who want everything possible done for them - versus minimalists , who believe in the wisdom of the body , and would rather allow the body to heal itself . They prefer letting nature take its own course and are very conservative.

Finally, there are the believers versus the doubters . The believers have faith that there is a solution for their problem - and that it's just a question of finding it. Doubters are typically skeptical and cynical - and are often paralysed when they need to make decisions, because they find it hard to trust anyone or anything.

There is no particular mindset which is better or worse. You simply need to know what your particular mindset is , so that you understand what your biases are , and can make the best use of your worldview. This will also help you understand that there are alternatives , which might actually be better for you , given the particular set of circumstances you find yourself in .

The final variable which patients need to consider is how much control and autonomy they want when they are making their medical decisions. Some patients are fiercely independent ; and want to decide everything for themselves ; while others are quite happy to let the doctor decide for them.

This is a great book for both doctors and patients . It will help patents to understand why there is sometimes so much difference between the opinions they get from different doctors . Don't forget , doctors can be maximalists and minimalists and doubters and believers as well - and this will colour the advise they give you ! It's a great book for doctors as well , because it'll help them to understand how and why they think; and why the patient sitting in front of them may have a different perspective. They can use this framework to help their patients make decisions which are right for them.

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