In a manner of speaking, doctors save lives
Putting the best light on choices moves patients to decisions
Words matter. They nudge patients into choices. Doctors — the architects of communication — wield powers greater than many of them realize.
In his own words, orthopedic surgeon and medical blogger Dr. Remo Aguilar presented two sides of the same coin:
A patient seeks a surgeon’s advice on a much-needed procedure and its risks. He asked two equally competent surgeons the same question: “What is my risk of dying in this procedure, doctor?”
Here’s what the two surgeons replied:
Doctor A: “Approximately one in 100 patients die in this procedure.”
Doctor B: “Approximately 99 percent of patients live well after this procedure.”
If you are the patient, would you undergo the procedure? If so, who would you most likely ask to do the procedure on you? If not, which surgeon dissuaded you the most?
Hypothetical and simplistic, this happens in many patient-surgeon conversations. In many instances, our answers are quite predictable. I probably wouldn’t undergo this procedure if I was listening only to Doctor A. If I chose to undergo the procedure, I’d ask Surgeon B to do the procedure on me. That is so, even if my risk for the procedure is technically the same between the two surgeons.
Surprised? Don’t be. There’s nothing wrong with you, either. Behavioral studies have suggested that many of our choices and consequent actions aren’t as rational as we believe it to be. We’re homo sapiens, after all.
What’s a healthcare provider to think? As it turns out, a lot.
“In our Philippine culture, most patients prefer to hear their choice for treatment from their MDs,” Aguilar said. “We have yet to come to that stage where we can delegate it to someone else.
“In some treatment strategies, we advise our patients,” he said. “We inevitably lay out optimal choices for them to decide on.”
Evidence first
When making optimal health choices, patients need to understand the facts — including pros and cons. They weigh the odds and make their decision.
“For reliability in health choices as a patient — and as a doctor — patient safety always has to be evidence-based,” said Dr. Gia Sison, an occupational health expert.
“Informed choices are important in healthcare along with shared decision making,” she said. “At the end of the day, we always want what’s best for our patients.”
Patients need to decide without undue pressure.
“Like most practice guidelines, there are recommendations for treatment and management,” said Dr. Yenyen Delgado, an HIV primary-care physician.
“It is important for us to discuss patient options without imposing,” she said. “Informed patient choice is top priority.”
Pharmacist Jarvin Tan was fresh from answering a patient’s “apprehensive questions” about an antidepressant medication. There had been bad experiences with another prescription.
That reinforced Tan’s most important factor for healthcare choice.
“My Top 1 is evidence,” he said. “The meta-analysis on antidepressants will tell me one particular drug was as close to the top as a previous medication. So, I’m more comfortable going back to it on the off chance.
“Top 2 is safety,” Tan said. “Our post-grad interns are probably tired of hearing me ask about cardiovascular risk data of anti-inflammatory and gout medications.”
Outcome counts
He and other doctors realize the average person doesn’t know such technical differences. Patients just want results.
“Service users are automatically at a disadvantage for my Top 2 criteria,” Tan said. “Only a few will be knowledgeable about their options.
“This is perhaps where the shared decision-making model can be applied,” he said. “Work with patients and service users as whole people beyond their diagnoses. Get them actively involved in the decision-making process.”
Among influences that should not decide health choices is advice from non-medical family friend “doctors.” This should be taken for what it’s worth: unfounded, uninformed opinions, wives’ tales and gossip.
“We just had a report about that on Filipino Psychology,” Tan said. “This is a challenge in the Philippine communities where doctors may be seen as ‘other people,’ but neighbors are ‘not other people.’
“So, no wonder healthcare professionals have a hard time helping patients understand antimicrobial resistance,” he said. “It would be better to establish rapport in line with community values. Then work with and enable them to choose to not abuse antibiotics.”
At what cost?
In countries rich or poor, price is often a factor.
“Cost might least likely influence my choices,” Delgado said. “However, it’s still a factor, especially if it’s the best evidence-based treatment or tool for diagnosis.”
When evidence is vague, choice hinges on how dire the situation is. If there are few alternatives, you hope for the best and take the treatment. Many times, doctors’ advice results from consulting with peers.
“I’m blessed to be working with experts in the field of HIV care,” Delgado said. “Healthy discussions with colleagues always helps.”
Tan agreed that talking with veterans is best.
“As an undergrad student I knew nothing,” he said. “When presented with an opportunity to make a choice, I consulted a pharmacist professor. Thankfully, he guided me in making a decision. So, it wasn’t just the resident who helped.”
Recommendations from brainstorming won’t be radical. That suits Aguilar just fine.
“Studies have shown that conservative options are better for patients who don’t have options,” he said.
About The Author
Jim Katzaman is a manager at Largo Financial Services and worked in public affairs for the Air Force and federal government. You can connect with him on Twitter, Facebook and LinkedIn.
