Thursday, January 15, 2015

Are Doctors Pros or Cons ?


One of most important roles doctors play is helping patients in choosing the right treatment. With an array of choices before them, patients are often confused. What adds to the confusion is their lack of knowledge about the options available. Distressed by this dilemma, patients look up to their doctor as a pro ( or a medical professional ) who will show them the right path. In other words, they treat their doctor as a trusted advisor.

Unfortunately, the doctor’s advice is often biased. Doctors, by virtue of being doctors, are predisposed to treat. It’s much like “Don’t just stand there – do something!” They are understandably partial toward performing medical procedures, because this is what they have been trained to do – and they are paid well to do these! So, if you have chest pain and go to a cardiologist, it’s quite likely he will advise you to go for an angiography, because this is what he has been taught as the right thing to do.  However, it might not always be the best advice for the patient, and this is one of the reasons there is such a huge trust deficit between doctors and patients today. Many patients rightly conclude that doctors tend to over-test and over-treat. This is why some of them believe that doctors are professional cons !

In the best of all possible worlds, the doctor will hold the patient's hand (well, not literally!) and help him decide for himself so that he makes the right decision. Good doctors do this all the time. They use the McKinsey system of making a mutually exclusive and exhaustive list of all the possible options – both medical and nonmedical – so that patients can work through these, sort out their priorities, and choose what works best for them.

However, making medical decisions can be an emotionally charged issue. For instance, when I suggest the alternative of adoption to infertile patients , they get upset and agitated. They feel I am being extremely negative, or may be because I doubt their chances with IVF. However, this is not true. I am just trying to be as unbiased and neutral as possible, and am consciously making sure that I don't censor the information I provide.

Sometimes, this can be a difficult task because patients simply misinterpret my intentions. This is where a second opinion can be very useful – especially if this is offered by a retired specialist. He can provide objective, trustworthy, reliable advice with no commercial interest whatsoever, because he is not going to provide the actual treatment himself.

Tools for helping you decide

Here’s where web-based Information Therapy can come in handy. The digital information provided is objective, neutral, and evidence-based. Patients can work through their options all by themselves, keeping in mind that the advice they are getting is tested and trustworthy.

However, just providing a list of options is not enough. Making a decision always involves an opportunity cost, because when you choose one option, you have to forego the other available choices – after all, you cannot have your cake and eat it too! Doctors need to provide patients with a process for decision making as well, so that that they can make the right decision for themselves.

A tool called 10-10-10 has been developed by Suzy Welch. The simple tool helps you think logically about the consequences of your decision. Ask yourself – If I select this option, how will I feel about it 10 minutes from now? 10 months from now? 10 years from now? Knowing your priorities will help you with the 10-10-10 process – in fact, this process can even help you discover them. It allows you to see matters from the right perspective, so that you are at peace with yourself.

Avoiding the bias and being adaptable

It’s important that the doctor makes it a point to be neutral and impartial. Most doctors, like all human beings, are full of biases that influence their decision, without even being aware of their personal prejudices. Being tagged as medical experts, many doctors try to act as founts of wisdom, so that they can help the patient decide because he is not clever enough to do so on his own. After all, don’t they know much more that the patient does? And shouldn’t they allow the patient to benefit from their wisdom, experience, and expertise? Isn’t this what the patient expects? And isn’t this what he is paying them to do?

This can be a very tricky issue, especially when the preferences of the patient differ from those of the doctor. This is why it’s important that the doctor behaves like a coach, and allows the patient to decide for himself.  Part of the doctor’s skill is to help the patient tap into his own heart and brain, so he can listen to what his body and gut is telling him. While it’s the doctor’s responsibility to ensure that the patient does not make a decision which can harm him, he also cannot hijack this key role and start making all the decisions for the patient. Just like a coach helps the athlete to tap into his inner resources, a good doctor gives the patient the courage and support he needs to look into himself and make the right choice.

Following this path will help patients to live with the consequences of whatever decision they make, no matter what the final outcome is. This is always uncertain in medicine, but if the doctor helps the patient to follow the right process, it will make the patient's, and the doctor’s, life a lot easier.
Some patients want the doctor to make the final decision because they believe that he is the expert, and they trust him to make the right choice. This is fine as well, because the doctor is then simply honoring the patient's preference.

Nonetheless, because all patients are different, doctors need to learn to adapt their styles to suit the patient’s needs. They need to be flexible, and behave like foxes, so they can do what’s right for the patient sitting in front of them, rather than behave as hedgehogs who are rigid in their approach. Doctors also need to be versatile, so they can tailor their behavior to meet the patient’s needs.


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