• Adam Tabriz, MD

Patients Know Their Opinion Is Important, But Who Is Not Listening?

Do Doctors Realy Need to Take Patients' Opinions Seriously, Or Is It The System That Has To Change?

Photo by Levi Meir Clancy on Unsplash

It is utter human nature to assume what others want or need. That is because human nature is a relative phenomenon, and more so, they are the most shapeable of all beings in the world. Unlike animals, humans possess an extra dimension: being judgmental. Furthermore, we also tend to default to one size fits all solutions. That is also applicable to today's healthcare and medical practice. For instance, not long ago, it was a common perception among the medical community that the only treatment for appendicitis was a surgical intervention. However, that is no longer the case; today, many cases heal with antibiotic-only treatment.

On a larger scale, of course, also compelled by human intervention, our healthcare system has taken a one-size-fits-all parallel approach.

But, is it still the physicians who are often reluctant to take into account patients' opinions, or is the something else that hinders their will to do otherwise? — that is a question that resembles a "Chicken n egg" expression which came first.

Undoubtedly, cultures across the globe have somewhat molded Western "Hypocritic Medicine" to fit their daily lives. Some cultures have set the relationship between doctor and patient as active mutual participation. Conversely, some cultures see such relationships as patients' passive followers through trust, openness, and respect.

Needless to say, as the population is stepping towards a more information-riddled world, almost every culture universally and parallelly adapts the concept of mutual patient-doctor collaboration from initial encounter and diagnosis to medical treatment.

But, still, quite often, physicians don't and most likely "can't" shake off the habit of one size fits all medical care, just like treating appendicitis by surgical intervention only.

Today patients, more than ever, share the decision-making responsibility with their doctors. In fact, according to a study report, the Portuguese population preferred a collaborative form of doctor-patient interaction except for life-threatening situations when they preferred doctors to decide on the faith of the treatment. The study also unveiled that younger and more educated people are more welcoming to shared decision-making than their lesser-educated counterparts.

Shared decision-making is a routine task. It may even sound straightforward. However, few physicians can master that job, so many patients have problems engaging in their respective medical care. Some recommend that one follow three simple steps to master a shared decision-making attitude based on option, choice, and conversation about making a decision.

First, they must have sundry choices to offer. Second, they must be able to explain those options to patients, often patient decision support integration, and finally, help patients explore alternatives and make determinations.

Many physicians are confident that they almost invariably incorporate patients' opinions in their clinical decision-making schemes. But one can never be sure. To clarify this, let us consider the two following scenarios:

Sam and David are two patients with prostate cancer. Sam is age 58 with no other medical conditions, and David is 79 with a long history of Diabetes, Coronary heart disease, and heart failure.

Both patients participated in their decision makings and agreed to have a prostatectomy (Removal of the prostate) and undergo chemical castration and radiation therapy. However, after doctors removed the prostate, the pathologist found no cancer tissue in sam's prostate. Once an error is discovered, the hospital administration starts an official investigation into the source of the mislabeled initial pathology report.

On the other hand, David completes the surgery yet realizes that even without surgery, his lifestyle would not have changed, and he would probably pass from other medical conditions than prostate cancer.

Now that David has completed the surgery, his health and lifestyle have turned downward, as he becomes depressed and anxious, and his heart failure has deteriorated.

One supposedly engaged both patients in their care, but both with paradoxical consequences.

Silent misdiagnosis is a serious phenomenon that occurs daily in technologically savvy societies. That is why we must be able to help patients recognize how meaningful their opinions are, and we must include the three-step rules mentioned earlier.

Shared decision-making between doctor and patient is the prime of every patient-centered medical care.

We must realize that simply telling a patient what to do isn't necessarily going to change their behavior. Because in an educated society, personal connection and rapport building is the key to shared decision-making relationships.

But, One Size Fits All Corporate Medicine Is The Telltale Sign Of Shared Decision-Making Delinquency

As we already realize, "Option and Choice" is the key to successfully shared decision-making between the doctor and the patient. Then again, numerous healthcare trends that primarily focus on saving costs also undermine the actual value of the medical care delivery to the patient. The weight and quality of care depend on what the patient wants and needs and not solely on what we offer the patient based on the prevailing standards and protocols.

Indeed, our corporate system, by default, focuses on cost-saving strategies, whereas we know that saving money does not necessarily equal better patient care.

The corporate entities, including insurance companies, pharma, and medical device, are currently reigning over three healthcare pipelines. Physician reimbursement, patient drug prices, and lobbying interests through politicians and the government have utterly distorted the options doctors can offer patients throughout the shared decision-making process.

Those who like to exploit the medical community with their rhetorical mottoes promoting shared decision-making between doctors and patients must first gaze out of their tunnel vision.

Indeed, shared decision-making is not simply about whether one should have treatment; and does not mean treating appendicitis surgically or by antibiotics. It should entail options about the flexibility of finding and talking to multiple experts and selecting the best medication for the patient, even if the insurance policy doesn't cover the cost. And even switch to a physician with more experience with certain medical cases without worrying about insurance reimbursement denial. And, if there is a limitation, it must be the patients' limitation and not boundaries enforced by the policies and protocols.

Lastly, quality determinants of patient care must incorporate patient (and treating physicians) preferences within their shared decision-making.

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