Our non-clinician professor was talking about how she did a study in which she found that doctors and patients thought of different things when they heard the phrase, "patient centered care."
Patients heard that they would be able to make decisions about their care that was best for them.
Doctors heard that they would lay out all the treatment alternatives, and then "try to convince the patient of the best decision." (emphasis mine)
The last phrase was said with this sarcastic overlay that could only have come from a non-clinician social scientist.
Was she trying to say that doctors shouldn't try to persuade their patients to follow a particular course of therapy?
My thoughts? Who the heck goes to a doctor and DOESN'T want their opinion? Doctors are not just prescription dispensers where you press a button, and ka-jing! out pops a cure for what ails you! I mean, isn't the idea that you're supposed to have a *discussion* with your patient about the pros and cons of various options, and then offer your opinion? You don't go to a mechanic and then tell them what's wrong with your car and then how to fix it! Well, I don't anyway.
Oh, and then there was the social work student who commented that "doctors were trained to pass judgments about patients, whereas in social work, [they] are trained to keep an open mind about them."
In the back of my mind I was thinking, "I'm sure she just means that we're trained to collect all the pertinent facts and then arrive at an impression and plan. She's just using some unfortunate phrasing."
But seriously? Gah!!! I was tearing my hair out. I suppose if I said anything at all to them about this, she would tell me that I've been indoctrinated into the medical sub-culture. There's just no winning, so I kept my mouth shut. You all would have been proud.
16 Pearls of Wisdom:
I try, very hard, to give my patients options and the pros and cons of each.
I don't like docs who take the view of "this is what we're doing, my way or highway."
Of course! I can't really think of a doctor who doesn't do this. You may have an opinion of what you think would be best given the patient's circumstances, and you may tell them that. But in the end it's the patient's decision. This is why we have DISCUSSIONS with them!!
You'd actually be surprised how many docs DON'T give options.
I always tell the patients that I am, at my very best, just their adviser. And family members and friends are, too. In the end, only one person makes the decision.
It's depressing to me that all these negative stereotypes about doctors have a pretty large basis in reality. On the other hand, since I'll be studying doctor-patient communication for at least part of my career, at least I know I'll always have a job.
:-P
And a blog, too.
Ah, yes, of course *all* doctors are arrogant and judgmental, and *all* social workers are modest and accepting.
Whatever.
Look, you came to the doctor. I didn't *make* you come. You came to me, so I'm gonna give you my opinion. Or, in the ER, I'm gonna tell you *why* we're doing what we're doing for your workup, and what the plan is next, and ask if you have any questions. But if you're just here to self-diagnose, or tell me that I can't help you, for whatever reason? Well, fuck you, too, and why did you even bother waiting six hours to see me?
(Man, but I have been in a *mood* lately.)
Every lesson I've had on informed consent (from medical ethics classes as an undergrad and classes from this 1st year in med school) have involved the physician providing options to the patients, the benefits and risks associated with each option, and finally their own personal recommendation. The patient has to personally weigh the risks vs. benefits, though, in order to make a decision.
Very curious how "patient centered care" is a new, hip phrase that has no uniform definition!
Erin -- It IS interesting, isn't it? I'd love to study patient expectations for their drs visits. One of my theories re: why patients are so dissatisfied with their drs is that they have NO IDEA what to expect when they go in for a visit, and no concept of what is a serious problem vs. a run of the mill benign problem.
I know I didn't before I went to med school, and I'd like to think I'm not a total idiot either.
G -- You're entitled to be in a mood. You're an intern after all. (Not for much longer though, how scary is that?)
Gabbiana- I once had a social worker tell me that "patients would never lie about what a doctor said or did to them."
This is a good post on social workers.
I actually had 5 social workers work for me as research assistants, and they were some of the most hard working responsible people I have had as employees. Don't know what they'd be like working as social workers, however.
Agree. I've worked with many excellent social workers.
And a few that make me want to tear my hair out.
And the same could be said for all the other fields I've worked with, too.
Well, to be honest, I DO go to a mechanic knowing what's wrong with my car. If I didn't, it might not get fixed right. I ask friends and family what they think of the noise or problem, research it online, and only then see a mechanic. I feel that's what I need to do in order to not get taken for a ride, so to speak.
And I think this may be how some people go about medical problems, too. I hear a lot of negativity about patients who try to educate themselves instead of relying completely on a doctor who may or may not be competent (I work with a program based on physician oversight and I've seen some horrible clinical decisions).
I don't think that physicians purposefully shove ideas down patients' throats, but it can come off that way. I just think that they may not be very good at listing the options available before making a decision on care or listening to the patient's reasons for choosing an alternative. Doctors sometimes have to acknowledge that a 10 minute interview can't tell them everything about a patient and sometimes the patient has knowledge that could help them make a decision, too.
Not all doctors participate in discussion. Granted, not all patients participate in the discussion, either, and just want THE ANSWER. It's a two way street, and it's easy to place blame on the doctors. But there's fault on both sides.
As for patient centered care being the hip new phrase, I think that's marketing for ya. I'm sure good physicians have been doing that for a long time now...
KA -- I didn't mean to imply that one shouldn't do research on one's symptoms (or on one's car) before going to the doctor (or mechanic). I suppose it's reasonable to have a potential diagnosis in mind when you go. I'm all for self education in order to prevent being screwed by an incompetent doctor or an unethical mechanic.
I think some of the negativity comes in when patients arrive at the doctor and expect a specific treatment that may not be appropriate. Say the patient thinks he/she has a chronic sinus infection and asks for antibiotics. But perhaps its a virus. Perhaps the patient has Wegener's Granulomatosis. That's why we go to doctors: to get their opinion about what's really wrong, and get the appropriate treatment.
Of course some doctors are assholes about patient self-education because they are insecure, but that's a whole 'nother issue. ;-) And yes, doctors sometimes shove. I've shoved when I thought my patient was being unreasonable -- sometimes it is not a bad thing to push.
>Was she trying to say that doctors shouldn't try to persuade their patients to follow a particular course of therapy?>>
Definitely some truth to this one. I've seen plenty of doctors fail to offer valid options they personally don't like. For example, a client I saw recently as a second opinion lameness had no idea any option other than an NSAID was available; I injected the horse's sore joint and life was good again about two weeks later. I know for a fact that the doc she'd seen previously simply doesn't like to inject joints (and is also afraid of being kicked, but that's another story).
I'm not usually insistent unless it's a life-or-death situation. Even then, I offer options ("either we go to surgery, or I kill your horse").
The discussion is the important part of patient centered care. If the patient is educated, they can lend information to the doctor's thought process, and the doctor can make a more well-rounded recommendation. In the end, though, it does fall to the doctor to steer to course of treatment, because that is his/her job!
Post a Comment