Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (2)

Patient choice: trust the doctor?

I’ve invited my Revolution colleagues to form a “blog fodder chain” – when we see something interesting on the Internet, or have a difficult question, we forward it to one another as a kind of challenge to write about it in our blogs.

I have to say, though – they keep sending me the hard stuff. Examples of physicians gone bad, morally questionable healthcare practices, and hot topics full of mine fields. I keep hoping for the “which puppy do you think is cutest?” question. But no such luck for Dr. Val…

Our Chief Privacy Officer challenged me again with some powerful food for thought. A recent article in the New England Journal of Medicine reports that some physicians withhold information (about treatment options) from patients if the physician objects to the options on moral or religious grounds.  Med bloggers Kevin MD and Medpundit also have recent posts about this article.

Well, of course this inspires initial indignation. Aren’t physicians supposed to offer all the options, with factual explanations of their pro’s and con’s, and then let the patient decide what they’d like to do?

Well, yes, they are. But the funny thing is that time after time when I’ve tried to do that for patients, they’ve expressed annoyance at me. They say, “you tell me what I should do, you’re the doctor!” And so after hearing this over and over again, I ended up truncating my explanation of options to the most “reasonable” ones and then allowing the patient to ask for more if they’re interested. Am I allowing my personal values to determine the hierarchy of options I present? Yes, probably so.

I’ve noticed that attention spans, even when it comes to important medical decisions, appear to be fairly short. Eyes glaze over when we try to explain all the subtleties of the options, and in the end (if the patient likes you and trusts you as a human being) he or she just wants to know what you’d choose if you were in his/her shoes – and why.

Am I being paternalistic? I hope not. I want patients to choose what’s best for them, but strangely enough their choice is often to let me decide. The power that patients impart to us is an honor and a privilege – and the reason why doctors are held to a higher moral standard than many other professionals. They are right to hold us to that standard. We must not squander their trust.

This post originally appeared on Dr. Val’s blog at

You may also like these posts

Read comments »

2 Responses to “Patient choice: trust the doctor?”

  1. Anonymous says:

    Tell me, Dr. Val: which puppy is the cutest?

  2. ValJonesMD says:

    Oh, thank you for asking me a FUN easy question! At long last!!! I vote for Molly:

Return to article »

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »