An outcomes article in the January 2011 issue of the Journal of Plastic and Reconstructive Surgery asks the question: “Are patients making high-quality decisions about breast reconstruction after mastectomy?”
The objective of the study was to “measure women’s knowledge about reconstruction and to evaluate the degree to which treatments reflected patients’ goals and preferences.” Their conclusion (bold emphasis is mine):
Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients’ goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making.
Granted the study was small, but it left me wondering if we the medical community fails to educate these women.
The study involved a cross-sectional survey of early-stage breast cancer survivors from four university medical centers. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. Only 84 patients participated (59 percent response rate). Participants answered only 37.9 percent of knowledge questions correctly. Read more »
*This blog post was originally published at Suture for a Living*
I used to think they didn’t, but they do.
Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard-worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good clinical judgment is when the gifted capacity of reasoning intersects with experience. Some doctors have better judgment than others.
Aristotle called this phronesis — or practical judgment.
Patients have practical judgment. We often can tell when something’s amiss with our own body. Things feel different or look different. Taking action on these observations is how we exercise judgment as patients.
Parents of children with central venous lines, for example, can often identify the early signs of infection before fever has ever appeared. They know the subtleties of their child’s behavior. The same goes for children with epilepsy. People with diabetes increasingly have the latitude to apply judgment to the management of their disease. This tends to be quite defined, however, with fixed variables and limited options for intervention. Read more »
*This blog post was originally published at 33 Charts*
Recently, I was involved in a discussion on an email list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term “patient” engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like “client” or something similar.
Having participated in the preparation and dissemination of the white paper on e-patients, I don’t see the need for “factions” or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated: “This is a big tent, with room for all.”
I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor-patient relationship that I have with them. They make the choice to enter into, or to activate or deactivate, the relationship with me. They may ignore my input, seek a second opinion, or fire me and seek the care of another physician at any time. They truly are in control in that sense. The only thing I have control over and am responsible for is trying to provide the best advice or consultation I can. Read more »
*This blog post was originally published at eDocAmerica*
Dr. Kent Bottles is in the midst of a very thoughtful multi-part blog post under the heading, “The Difficult Science Behind Becoming a Savvy Healthcare Consumer.”
Part I examined “the limitations of science in helping us make wise choices and decisions about our health.”
Part II explores “how we all have to change if we are to live wisely in a time of rapid transformation of the American healthcare system that everyone agrees needs to decrease per-capita cost and increase quality.”
Both parts so far have addressed important issues about news media coverage of healthcare. Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
I regularly talk to my patients’ parents about social health. What parents do, what they think, and how they socially experience their child’s health problems has become an interest of mine.
I can hear it now: “Of course patients won’t discuss their social health activities with you, you’re a doctor.” Perhaps, but I don’t think so. Actually, I’ve had some very interesting open dialog with a few of my long-term patient-parents. Many have children suffering with chronic diseases such as Crohn’s disease, eosinophilic enteropathy, and the like. The relationships I cultivate are open, and the nature of my dialog has been just as consistently open as other aspects of our relationship.
Interestingly, while nearly all have used online search to understand their disease, most have never connected with other disease sufferers in the online space. The concept of crowdsourcing is met with puzzled looks. Sure they’re e-patients, but I would characterize most of my patients as e-patients. The question is: What does that really mean? Read more »
*This blog post was originally published at 33 Charts*