Doctor Who? Are Patients Making Clinical Decisions?

ScienceDaily (Feb. 12, 2008) — Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care. In a study just published in Clinical Orthopaedics and Related Research, Dr. J. Bohannon Mason of the Orthocarolina Hip and Knee Center in Charlotte, NC, USA, looks at the changes in society, the population and technology that are influencing the way patients view their orthopaedic surgeons. As patients gain knowledge, their attitude to medicine changes: They no longer show their doctors absolute and unquestionable respect.

Demographic change, education, affluence, availability of information via the Internet, patient mobility, direct-to-consumer marketing, patient age, patient activity demands, cost pressures and physician accountability are converging to present the practitioner with a patient who is more informed and has higher expectations than any prior generation of patients.

Today’s patients do not simply have a medical complaint, they desire a particular operation and sometimes even a particular implant. The doctor is no longer the sole source of medical information. Patients have enough snippets of information to stimulate a dialogue and clearly express their expectations for a particular outcome and technique to achieve that outcome. They are also demanding quicker recovery, return to higher-level sport activity and earlier discharge from the hospital.

“Patients have come to expect miracles in medicine as the norm, yet these miracles are not without inherent risk,” cautions Mason.

Providing true patient-centered care relies on doctors’ ability to supply patients with accurate, evidence-based information and to improve communication. However, patients are not necessarily motivated by evidence-based medicine. They are often willing to adopt the promises of direct-to- consumer marketing.

In Mason’s view, the doctor’s responsibility is “to maintain control of validated information sources and of the exchange of information with the patient. [Doctors] need to be interpreters and balancers of scientific information to help guide [their] patients through the maze of medical hyperbole. [They] need to discuss new treatments and technologies openly and honestly.”

And crucially, they must also understand that although patients’ demands are changing, the surgeon’s accountability and responsibility for their patient’s safety and care have not.

Journal reference: Mason JB (2008). The new demands by patients in the modern era of total joint arthroplasty. Clin Orthop Relat Res (DOI 10.1007/s11999-007-0009-2)

The important part is how better-informed patients address their physician. Typically, good doctors do not resent, and in fact appreciate it when patients understand something of what is going on.

A large percentage of patients are “I hurt, fix it” types, who neither know no care how or why.

Others are very cost conscious, so are very intent on the price of various treatment alternatives.

Self-diagnosticians are often annoying, as are hypochondriacs, because they have unrealistic expectations of both what is wrong with them, and how to deal with it.

Importantly, physicians are *not* pharmacists, so never assume that their knowledge of pharmacology *or* drug interactions, *or* non-drug interactions are adequate.

Typically, physicians are far less interested in patient input for acute conditions than chronic conditions. Acute conditions usually need prompt and immediate care, but there is a lot more flexibility with chronic complaints.

However, for *some* acute conditions, such as heart attack and stroke, hospitals and emergency rooms vary wildly as to their typical course of treatment. If a patient has a strong inclination to such a condition, it is not unreasonable to find out what the standards are in local hospitals ahead of time. It could be the difference between life and death.

For complex and chronic problems, especially those that are undergoing extensive research and development, like arthritis, it is wise to do Internet research, then ask your physician about specific therapies, what they think of them.

For decades now, medical knowledge has grown at such a rapid clip that it is next to impossible for practicing physicians to keep up to date, and there is a good chance you might find something new and interesting to them. Be sure to save the URL, as they will need to see it for themselves.

I quite agree. Even in the 1960s, the pace of medical innovation and discovery has been overwhelming for MDs across the board. They can either practice or research. Not enough hours in the day for both.

I was in Europe in the Army right when a large class of NSAIDs were being introduced, and after a few dangerous mistakes, all soldiers were required to have their prescriptions verified by the company XO, using a PDR, before taking them. The Doctors were using trial and error to find out which ones they preferred to prescribe, because there were so many new alternatives.

It really helped when a company commander received a new drug that “may, in unusual cases, cause hallucinations”.

He needed to take the afternoon off.

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.