Tuesday, April 10, 2012

When patients know more than their doctors do

Life used to be much easier in the past for both patients and doctors, when doctors were acknowledged to be the medical knowledge experts . They knew all there was to know about treatment options for all kinds of diseases . They spent many years in medical college , learning from their medical textbooks and their professors ; and since medicine is a professional guild , they transmitted information to each other and shared experiences by reading medical journals and attending medical conferences . They know what to do when the patient had a problem, which is why patients went to them when they fell ill . They were able to provide solutions which the patient would accept , because he knew that the doctor knew much more about how to solve their problems , than they possibly could.

However times have changed, Firstly, with the explosion of medical knowledge, there’s really no way a doctor can keep up to date with all the changes which occur in medicine . Most doctors have become specialists, who know a lot about their own particular field , but understand very little about what's happening in other areas . Unfortunately , patients don't come with neatly packaged problems with well defined diagnostic labels. Most have more than one disease and will often have multiple problems. So while a gynecologist may know a lot about treating heavy menstrual periods , she may not know anything at all about the glaucoma which the patient also happens to have . Secondly, it’s become much easier for patients to become well informed about their medical problems . There is a wealth of reliable information available online - a lot of which is written for patients , and a lot of which is was written by patients. This helps patients to become experts on their problem , and armed with information therapy, they often know much more about their own diseases that the doctor will . Finally , it’s patients who are the experts on their own bodies. They have their own worldview, and know exactly how they want be treated as human beings - not something which a doctor can figure out within a 15 minute consultation !

Some doctors respect the fact that there are intelligent patients who are experts on their disease ; and are willing to listen to their opinion . They respect their patients and encourage them to provide inputs , so they can tailor the right treatment protocol for each individual patient. However , many doctors feel threatened by well informed patients . They will use pejorative statements , such as – Who’s the doctor here – you or me ? If you don't like my advice , go find another doctor !” This is a very paternalistic approach which is a hangover from the past, and is not something which works well today .

However, there are patients who feel intimidated and threatened , and because they are scared of their doctor, they will passively listen to whatever the doctor dishes out. The truth is that there are often areas in which you are likely to know much more about your problem than your doctor; and you need to be respectful and share this information with your doctor , so you can work together as partners in your medical care.

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1 comment:

  1. The concept of patient's autonomy has taken roots in clinical medicine in last several decades in the West. That means dialog -based clinical-medicine has become prevalent in the West. In ethical terms, doctors provide information to the patients and the latter make decisions. Whereas in the developing world, it is still more of paternalistic medicine, ie, doctors dictating what is good and what is bad for the patients.


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