Friday, July 06, 2012

Does the doctor know best ?

Physician treating a patient. Red-figure Attic...

I often ask patients for their inputs as regards their medical treatment. Infertility treatment is elective,  and because there are always a number of options available , it's very important that patients have a say in the treatment they select, so that they have peace of mind they made the right decision for themselves.

Should an older woman consider using her own eggs , even though she knows this will reduce her chances of getting pregnant? Or should she use donor eggs , because this has a much higher success rate?  Will she be comfortable with the fact that she's not providing her own DNA for her baby? Is donor embryo a better option for her?

These are all difficult questions , and patients need to come up with their own answers, which is why I ask my patients to think about what they want to do . Often , the patient will reply -  We will do what you tell us to do - after all , you are the doctor , you know best.

While it is true that I am a medical expert , these are decisions which are very personal , and they need to be made by patients themselves.

It’s useful to conceptualise three different areas in medicine.

In one area, it is the doctor who is the expert. This is the area of medical facts and knowledge – which involves interpreting lab reports and making sense of CT scan images . While patients do need to be well informed and intelligent , they do not need to acquire medical expertise, which is why they go to a doctor. A doctor is a skilled professional , who takes responsibility for making sure he is well-informed and that his medical knowledge base is up-to-date, so he can use it for his patients’ benefit. The doctor here serves as a trusted professional.

In the second area, it is the patient who is the expert. She is the expert on her own body – and she knows what her personal preferences are .  Doctors cannot be mind readers , and cannot possibly be expected to know what's inside the heart of each patient, unless the patient is willing to share this information with them.
The final area is the area of overlap, where both doctor and patient need to discuss what the best course of action is. Here the doctor serves as friend, counselor , philosopher and guide.

Intelligent patients and doctors understand that these three different areas require different approaches.  While there may be a certain overlap , if they demarcate the boundaries , they will be able to make use of each other's skill sets to form a win-win partnership , where everyone benefits.

As regards matters of the head, it is the doctor who is the expert . Because he has the technical expertise and can get in touch with colleagues around the world , he can make suggestions as to  what the best course of action is , based on evidence-based medicine. However, as to matters of the heart , you are the expert !

Remember that this is a partnership , and if you acknowledge and respect each other's expertise , you can take advantage of your complementary skill sets. Just like it's not possible for patients to become technical experts on their medical problem in a few days, it's not possible for a doctor to understand what your personal preferences are in the few minutes provided during a consultation. This is why working together is the best possible solution , where both of you play to your strengths.

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