Bioethics Discussion Blog: The Patient: How Do I… How Should I know What I Know?

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com

IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice

FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD

Sunday, October 14, 2007

The Patient: How Do I… How Should I know What I Know?

In the not so distant past, yet it was in the past, patients went to the doctor for advice and help and the doctor freely (well, at some fee) provided the patient with both. Those were the days of physician paternalism and patients were not expected to ask much, think or do except to do what the physician advised. Oh my, how times have changed since then. Now it’s patient autonomy. It is the patient that holds the personal decision making power. Physician paternalism in the form of “I know what is best for you and I would advise you to listen and accept what I say” is virtually gone. If anything is left, it is the patient asking the doctor “If you were in my condition, what would you recommend for yourself?” And the physician will think that giving advice from a very personal point of view is inappropriate these days because paternalism is out and doctors shouldn’t talk about themselves or disclose their own personal preferences. So the doctor might respond by saying “What is more important is what you would decide.” Not much is accomplished in that verbal transaction.

As I said, times have changed and now the patient can answer “How do I know what I know” by referring to the directed research on the internet with the power of search engines, reading medical websites and medical blogs such as mine, discussing specific medical issues with visitors to listservs, message boards, chatrooms, and spending a moment reading internet advertisements that seem to pop up here and there but seemingly appearing appropriate to the topic being searched. In addition, the patient easily has access to TV medical dramas and radio, TV and other media “medical news” and as a last resort there is the direct to consumer pharmaceutical company advertising their most valuable drug for a symptom most everyone might have whether it has been diagnosed or not.

What patients also know about their medical problem is what physicians tell them in an attempt to provide some medical education but also informed consent. But an important factor in beneficial and effective doctor-patient communication is the lack of time and perhaps interest by the physicians in a back and forth exchange. Carrying out this exchange will allow the doctor to really understand what the patient doesn’t understand and provide education. It will also allow the patient to understand what the doctor doesn’t understand about the patient’s knowledge and goals and to express them more clearly.

What is important in this era of diminished physician paternalism and heightening of patient autonomy is to promote and accentuate the importance of patients looking to their physicians as a very important resource for their medical education with the physician’s medical expertise. More than just providing medical facts to patients, physicians may have the special skills through training and experience of how to interpret the facts and apply them to the patient’s illness. Patients may not aquire this ability through their outside reading.

Physicians should also look to their patients as folks who most likely are not empty containers of medical information but may very likely be overflowing with good information (and indeed good information about which the physician has not yet read or heard and needs to be educated). But the patient may also have a lot of misinformation too which needs to be corrected and or more realistically applied to the patient’s illness.

So I think the answer to “How should I know what I know?” should be answered by learning through using the patient’s own resources beyond the doctor’s office but also looking toward the patient’s physician as the most knowledgeable resource for the patient’s specific symptoms and disease. Both parties must work together, each bringing their own potentials to provide for the best chance for a successful conclusion of whatever the medical challenge.

For more reading on this topic, you can find the article “How Do Patient’s Know” by Rebecca Kukla in the September-October 2007 issue of The Hastings Center Report. ..Maurice.

4 Comments:

At Monday, October 15, 2007 1:16:00 AM, Anonymous Emily said...

At the end of every doctor's visit, as I pull out my list of questions, I'm sure I hear the doctor sighing. I used to be a passive patient until I got a computer, now I can't help myself. The questions are not general, but specific to my condition, which only he can address. I hope he understands and doesn't consider it a waste of his time. I always express my appreciation before I leave.

 
At Monday, October 15, 2007 7:48:00 AM, Blogger Maurice Bernstein, M.D. said...

Emily, I fully agree with your actions, particularly that you ask questions specific for your own condition which only your doctor can address. The fact that you keep your questions pertinent should encourage the physician to answer and not consider your questions a waste of precious time. ..Maurice.

 
At Saturday, December 08, 2007 5:14:00 AM, Anonymous jbe said...

I encourage my patients/clients to learn about their illnesses. In mental health we have fewer ways of reaching "objective" diagnoses, and it is important to weigh the various differentials. Patient input is vital. I do temper my encouragement with the caveat that patients (and their families) need to discuss their findings with the provider rather than hopping from provider to provider to find someone who agrees with them.

 
At Saturday, December 08, 2007 7:15:00 AM, Blogger Maurice Bernstein, M.D. said...

jbe, it would seem to me that by a physician or other mental healthcare provider listening to how the patient interprets and expresses their symptoms and their own suspected diagnoses can help the provider understand the role the symptoms are playing in the patient's life along with the patient's concerns about their illness. ..Maurice.

 

Post a Comment

<< Home