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.