Tuesday, October 25, 2011

Confused patients - and confused doctors !

All good doctors know that medicine is not an exact science and there are often multiple options to treat a particular problem. It's very easy for a doctor to tell the patient what to do ( and this is something doctors are trained to do all the time), but often this is not in the patient's best interests.

However, when the doctor tries to explain the fact that there are options to the patient , and then asks the patient to provide inputs as to what their preferred course of action is, this sometimes creates a lot of anxiety, stress and tension in the patient's mind. For one thing patients aren't used to making decisions like this, so they are often clueless and don't know how to proceed.

For another , they expect the doctor to make these kind of decisions for them. They are surprised when the doctor offers choices to them. Some of them feel ( in the back of their mind ) that the Doctor must be incompetent if he cannot makes these decisions himself ! After all, aren't they paying for his expertise to make the right decision ?)

It's important for doctors to level with patients , and to communicate with them that often there are no black-and-white answers in medicine. Lots of topics are fairly controversial , because medicine is an evolving science. There are often no easy answers to some complex situations.

Let's take the case of the patient whom I saw who had a small polyp and required an embryo transfer . Some doctors recommend that the polyp be removed before doing the transfer ; while others feel that a small polyp does not affect the chances of embryo implantation. I explained both these choices to her , and then asked her what she wanted me to do. She was completely paralyzed and kept on insisting that I make the decisions for her , because she felt that I had superior knowledge and more experience ; and would be able to provide her with the " right : answer. When I explained that often it's six of one, half dozen of another she didn't know how to proceed.

It is important that we realize that it's not only doctors who have a particular philosophy . While some doctors are quite aggressive, others are conservative. Patients have a certain philosophy as well, and while some will do everything possible to avoid surgery , others are much happier with a quick fix surgical solution.

The problem is that often the doctor has no way of knowing what the patient's personal preferences are , which is why good doctors will explicitly ask patients these questions , and factor in their personal preferences , when making such important decisions. It's very easy for doctors to be dogmatic and say - This is the right way to do it ; or to pretend that this is the only way to do it , but this is actually not in the patient's best interest.

The patient is then being deprived of the information that there were alternative options available to handle that particular problem. I prefer taking a straightforward approach and explaining the options upfront to all patients, but sometimes this also has the downside of leaving these patients very confused.

The important thing is to step back , look at the big picture, and understand why some of these quandaries occur in medicine . When I offer a choice, I also tell them that the very fact that I'm offering them an option means that both options are equally correct from my professional perspective . I explain the pros and cons, and tell them that as their doctor, it's my job as a professional to make sure that I will not let them make a wrong decision ; but when there are options , it's important that they apply their own mind and use their own personal preference system , so that I can factor this in , when helping them to make the right decisions for themselves.

When your doctor asks for your opinion, this does not mean that he does not know what to do ! In fact, it means that he is a real expert, who can look at the big picture; understand that there are choices available; and it willing to respect you so that he can factor in your personal preferences before making a final decision. It's only doctors who are insecure who get upset when discussing choices and who deceive the patient by pretending that there's only one right way of doing something in medicine !
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