Wednesday, February 15, 2012

Should doctors tell patients what to do ?

There are many doctors who don't like patients who ask questions and argue with them. They basically want their patients to agree with their advice and to just do what they are told by the medical expert. The get irritated when patients want to discuss alternative option they have found on the internet. These the doctors have a paternalistic approach and sincerely believe that patients do best when they follow the doctor's orders, rather than try to apply their own mind and make decisions for themselves. There doctors don't like patients who have made up their own mind. This is often the case of an irresistible force meeting an immovable object ; and because the chemistry between the doctor and patient is never right, they never managed to hit it off ; and may end up hitting each other ( figuratively !)

There are also doctors who want patients to provide inputs and to make their own decisions for themselves. These are the doctors who will make a list of options , and ask patients to select the option which they prefer. They get irritated when patients refuse to do their homework; and they dislike patients who want to just passively follow the doctor’s advise, because they feel that their doctor is God !

One would think that this is a very enlightened approach , because it treats the patient as an empowered adult; and that patients would appreciate doctors who treated them as intelligent partners. However, there are some patients who don't like this kind of doctor, because they believe that these doctors are wishy-washy and confused and can't make up their own mind ! These are the kind of patients who want authoritative doctors who will just tell them just what to do. They’d rather not than discuss the pros and cons with their doctor, because they feel that all this discussion just leads to paralysis by analysis and creates more confusion, rather than solving problems.

These patients want a doctor who will guide them and make the decisions for them - someone who's a father figure , who will tell them what the best treatment option is for them. These are patients who can't be bothered to apply their own mind , because they don't think it's worth the effort. Why not leave everything to the expert ? They believe that half knowledge is dangerous ; and that it's better to leave such critical decisions up to the professionals , who are trained to make them , and presumably will make better decisions as compared to an untrained layperson.
I don't think one type of doctor is any better than the other type . In fact , a really good doctor will be able to tailor his approach to what the patient needs. However, if there is a mismatch between the worldviews and personalities of the doctor and the patient, both are likely to be unhappy . On the other hand, when the patient who is seeking an authoritative doctor finds a doctor who has a paternalistic mindset, both are likely to be happy. Similarly, if a patient who believes in making decisions for themselves finds a doctor who believes in offering patients choices , so that they can choose their path for themselves, they are both likely to do well with each other.

As the patient, sometimes you may not have much of a choice ; and you may be forced to live with a doctor who has a philosophy which is diametrically opposite to yours. You should be aware of this , and realize this is likely to create a lot of angst and unhappiness for both of you. However , if you do have a choice , it's well worth spending some time searching for a doctor who shares your worldview - you’ll both be a lot happier !

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  1. Anonymous9:29 PM

    Dear Dr,

    Should doctors tell patients what to do? Ofcourse, that is also part of their job, isn’t it? Autonomy of patients begins with the selection of his/her doctor and ends there too. From that point onwards it must be a team work between the doctor and the patient. Doctors are specialists who dedicate 7-8 years of their lifetime for learning medicine. How can somebody expect patients to understand their condition in a few hours or days and take an appropriate decission? I think patient autonomy is severely mistook. Not all patients can make intelligent decissions no matter what their educational qualification is but for sure every patient can understand the details of their illness. I am sure if a doctor becomes a patient, he too will be desperate to hear expert opinion on how to carry on? Then think of a patient without prior medical knowledge. Instead of giving a patient several options to begin with, a doctor must first decide what is the best option for the patient and then explain the patient why this option is the best according to him and also list other options that are available. In this way the doctors can respect their patient’s autonomy and can also help them decide. I am sure most patients, like me, need an intelligent and caring physician to decide for them. In this way they do not have to carry the burden of sickness and also the stress of taking crucial decissions about their health. I think a really good doctor will put himself in the patient’s place and decide what option would be best for the patient. I read an insteresting article in BBC about how doctors chose a different treatment option for themselves when faced with a hypothetical question about a medical treatment and chose a different treatment option for their patients. The study said a doctor will always think of saving his patient’s life even if the treatment process (potential side-effects) compromises the patient’s quality of life. On the other hand when he has to peronally decide for himself he will take a decission which will not compromise his life quality even if the risk of death is higher. This is something interesting every patient should know ☺. Should doctors decide for patients? YES. Shoul patients leave everything to a doctor? NO. Somewhere a balance inbetween !

    Your blog gives a new dimesion to the way I think. Thank you :)

  2. I agree the secret is to find the Middle Path, as advised by Gautam Buddha.

    If you are lucky, and you have a thoughtful, caring, intelligent, well-read, empathetic doctor who is willing to put your interests first, that's great ! Sadly, not many of us are going to be lucky enough to find Dr Right :(

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