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Why Doctors Hate Science

Professor Yaffle said:
I think the only difference is that Linda thinks that after listening to the patient's concerns, the doctor should take the decision, as opposed to the doctor helping the patient to make the decision.
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I think decisions should be fully informed and that it's unrealistic to expect patients to be fully informed.

Linda
 
fls said:
Wouldn't it be simpler to just tell the doctor that?

Linda
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Yes. How would the patient manage to do that if the doctor had already chosen the medication?

"Here are three roughly equivalent courses of action. This is the one I've picked."
 
fls said:
I understand that, and of course nobody likes it. Hence the need for the illusion.

Linda
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There is no need for any illusion IMO. If a patient and doctor can come to an *agreement* as to what is the best course of action, there is no need to quibble about who actually made the decision. I have seen some good doctors too you know.
 
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Ivor the Engineer said:
Yes. How would the patient manage to do that if the doctor had already chosen the medication?

"Here are three roughly equivalent courses of action. This is the one I've picked."
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That's a good example, then. Maybe the three choices don't include the best choice if the pill type is important, unless you mention it beforehand.

But that's an easy way to make it look like the patient is making an informed decision - letting them pick the prettiest pill. Yeah, we're partners.

Linda
 
More seriously, many GPs will print out a prescription before they even tell you what they are giving you. This then makes it seem like an imposition and a nuisance to say anything that might make them reconsider.
 
fls said:
I think decisions should be fully informed and that it's unrealistic to expect patients to be fully informed.

Linda
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Why? So long as patients have:

a) been made aware of the different options for treatment

b) and the risks and likely outcomes of each of the treatments

c) had their concerns and preferences taken into account

they are making a fully informed decision, unless their doctor is misleading them, either through ignorance or self-interest.

What other knowledge do patients need to be fully informed?
 
fls said:
That's a good example, then. Maybe the three choices don't include the best choice if the pill type is important, unless you mention it beforehand.

But that's an easy way to make it look like the patient is making an informed decision - letting them pick the prettiest pill. Yeah, we're partners.

Linda
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Yes Linda, being patronising is an extremely good way to get the patient to shut up and stop bothering you about what you consider to be minor things.

Some doctors have it down to a fine art.
 
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Professor Yaffle said:
More seriously, many GPs will print out a prescription before they even tell you what they are giving you. This then makes it seem like an imposition and a nuisance to say anything that might make them reconsider.
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Oh, I know. I've been there as well.

Linda
 
fls said:
That's a good example, then. Maybe the three choices don't include the best choice if the pill type is important, unless you mention it beforehand.

But that's an easy way to make it look like the patient is making an informed decision - letting them pick the prettiest pill. Yeah, we're partners.

Linda
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"Yeah, the doc gave me these to take, but they're just so hard to swallow. I couldn't face having to take the full course."

Obviously the above situation can be mitigated by the doctor being even more paternalistic and making it absolutely clear how important it is to finish the course.
 
Ivor the Engineer said:
"Yeah, the doc gave me these to take, but they're just so hard to swallow. I couldn't face having to take the full course."

Obviously the above situation can be mitigated by the doctor being even more paternalistic and making it absolutely clear how important it is to finish the course.
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yes, or he could not say that, and allow the patient to stop the course, and then return with their infection still present, garnishing money for another visit, and give them a different type of antibiotic.

Not every suggestion is meant to be paternalistic.

TAM:)
 
Professor Yaffle said:
Yes Linda, being patronising is an extremely good way to get the patient to shut up and stop bothering you about what you consider to be minor things.

Some doctors have it down to a fine art.
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See? I point out that the asymmetry in knowledge and experience is not amenable to 5 (or 10 or 15) minutes of discussion, and it is necessary to berate* me. It's like we've turned beneficence into a dirty little secret that nobody's supposed to reveal.

Linda

*a gross exaggeration ;)
 
fls said:
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It's like we've turned beneficence into a dirty little secret that nobody's supposed to reveal.

Linda
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How does the physician know what is "good" for the patient?

I.e. the physician only has an estimate of the patient's utility function, and a biased one at that. Not everyone weights the 5 D's the same as doctors do.

ETA: To give an example: if I ever need even minor surgery on my eyes, I will have to have a general anesthetic, even though a local may be safer.
 
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fls said:
See? I point out that the asymmetry in knowledge and experience is not amenable to 5 (or 10 or 15) minutes of discussion, and it is necessary to berate* me. It's like we've turned beneficence into a dirty little secret that nobody's supposed to reveal.

Linda

*a gross exaggeration ;)
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Come on Linda - you have a very obvious sarcastic streak. Some doctors can turn that off when they are with patients (I have no idea whether you are one of them), but others seemingly cannot keep their sarcastic/arrogant/condescending/patronising personalities out of the surgery. This in turn makes many patients reluctant to bring up anything that doesn't fit in with what the doctor already has planned.

To me the problem is not about *who* makes the decision, as long as the patient has been listened to and their views taken into account. The main problem, for me, is that many doctors create an atmosphere wherein patients find it very difficult to provide this sort of input. It's not enough for a doctor to say "well they didn't tell me about their problem with x" when they have created a situation in which it is very difficult for the patient to air their concerns. See Ivor's link to the book about communication skills.
 
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how does an engineer know "what type" of steel is best to build that skyscraper from?

I mean maybe legos would be more what I prefer, or cork. Maybe I don't want my skyscraper built from Steel or Concrete.

TAM;)
 
fls said:
See? I point out that the asymmetry in knowledge and experience is not amenable to 5 (or 10 or 15) minutes of discussion, and it is necessary to berate* me. It's like we've turned beneficence into a dirty little secret that nobody's supposed to reveal.

Linda

*a gross exaggeration ;)
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And here I was just going to say, go to med school if you don't like it.
 
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