Why Doctors Hate Science

[Ivor the Engineer]

<snip>

I would say about 30% of my practice wants a father figure physician.

TAM

Which patients do you prefer dealing with: those who want you to decide, or those who use you as a source of reliable information?

 

[Ivor the Engineer]

I'm ER doc so the variation is too wide to draw a firm conclusion.
Older, lower educated and poorer patients tend to want you to tell them what to do more than younger, educated and more affluent patients who wants to be more involved.

That makes sense. Which do you prefer?

 

[Professor Yaffle]

I would think most people lie somewhere other than the extemes of this continuum. I like my doctor to give me all the relevant information, but also for them to tell me what they think the best course of action would be.

 

[fls]

I would think most people lie somewhere other than the extemes of this continuum. I like my doctor to give me all the relevant information, but also for them to tell me what they think the best course of action would be.

I'm sorry, but how is recommending the "best course of action" paternalism?

Linda

 

[Ivor the Engineer]

I'm sorry, but how is recommending the "best course of action" paternalism?

Linda

I think it depends on the particular treatment and the prognosis. E.g., in the case of chronic or terminal diseases there are often more intangible factors involved in a person's decision as to what the best course of action is.

 

[Professor Yaffle]

I didn't say that it was.

To clarify: I have had doctors who have just doled out a prescription without telling me anything, and I have had doctors give me information whilst being very reluctant to offer their opinion on the best course of action - leaving me to make the decision entirely on my own. I don't like either of those approaches - but somewhere inbetween.

 

[fls]

I think it depends on the particular treatment and the prognosis. E.g., in the case of chronic or terminal diseases there are often more intangible factors involved in a person's decision as to what the best course of action is.

Why assume that can't be taken into account?

Linda

 

[fls]

I didn't say that it was.

To clarify: I have had doctors who have just doled out a prescription without telling me anything, and I have had doctors give me information whilst being very reluctant to offer their opinion on the best course of action - leaving me to make the decision entirely on my own. I don't like either of those approaches - but somewhere inbetween.

Paternalism isn't the act of making a recommendation or decision, but rather not volunteering information?

Linda

 

[Professor Yaffle]

Well if you are not given the information to be able to assess your choices, and the doctor just makes a decision, that is paternalism - right? Or am I misunderstanding the term?

 

[Rolfe]

It's funny how altmed proponents like to criticise doctors fro being paternalistic, while displaying the worst aspects of that paternalism themselves. Indeed, a lot of the attraction of altmed seems to be the authoritative, guru-like pronouncements of the therapists. Makes people feel that someone else is in control and handling their problem for them.

Rolfe.

 

[Professor Yaffle]

Having done a quick google to familiarise myself with the lingo... I dislike both strong paternalism and the independent choice/decision-making model and favour (in general) something closer to a model of qualified independence or "enhanced autonomy".

​

 

[Skwinty]

I always thought that libertarians were the proponents of paternalism as libertarians are the antonym of authoritareans.
I spent over an hour with a new GP today, who incidentally looks a lot like Linda, if the picture in Linda's avatar is indeed Linda. My experience with doctors are as follows:
1. I consult with a Doctor because I don't know what is wrong with me.
I do know however, that there is something wrong with me.
2. The Doctor can do nothing if I sit there and say nothing, so I must participate in the process.
3. Once the Doctor has made a diagnosis, it is not normally a long list of possibilities, and the prescribed treatment is not normally a long list of possibilities.
4 The Doctor would normally say this is your condition and this is the prescribed treatment for your condition.

If the Doctor were to say, this is your condition and here is a list of alternate treatments, please choose one, I would not be impressed, although if the Doctor said this is the treatment I am prescribing and it involved something that I was wary of, I would ask for possible alternatives.
To classify Doctors as paternalistic implies that the patient is passive or weak and unable to participate in the diagnosis.

 

[Professor Yaffle]

I always thought that libertarians were the proponents of paternalism as libertarians are the antonym of authoritareans.
I spent over an hour with a new GP today, who incidentally looks a lot like Linda, if the picture in Linda's avatar is indeed Linda. My experience with doctors are as follows:
1. I consult with a Doctor because I don't know what is wrong with me.
I do know however, that there is something wrong with me.
2. The Doctor can do nothing if I sit there and say nothing, so I must participate in the process.
3. Once the Doctor has made a diagnosis, it is not normally a long list of possibilities, and the prescribed treatment is not normally a long list of possibilities.
4 The Doctor would normally say this is your condition and this is the prescribed treatment for your condition.

If the Doctor were to say, this is your condition and here is a list of alternate treatments, please choose one, I would not be impressed, although if the Doctor said this is the treatment I am prescribing and it involved something that I was wary of, I would ask for possible alternatives.
To classify Doctors as paternalistic implies that the patient is passive or weak and unable to participate in the diagnosis.

Its not just about the diagnosis though. Once diagnosed there are often many different avenues with regards to treatment. These treatments (or decisions not to treat) can have different strengths and weaknesses which will have different priorities for different patients.

For example if I am in the early stages of pregnancy and suffering symptoms of depression (and previous bouts of depression have only been affected by an antidepressant for which the effects in pregnancy are unknown), I don't want the doctor to independently make the decision about how I should be treated, and neither do I want the doctor to simply say "untreated you might get worse, but the anti-depressant could possibly harm the foetus - come back to me when you have made your decision".

 

[Skwinty]

Its not just about the diagnosis though. Once diagnosed there are often many different avenues with regards to treatment. These treatments (or decisions not to treat) can have different strengths and weaknesses which will have different priorities for different patients.

Sure, if the presciption says you need a heart transplant and you have no medical aid or finances, then ultimately the doctor says you are going to die. What other choice do you have, other than an alternative treatment like homeopathy, crystal healing, faith healing or chiropractic.

 

[Ivor the Engineer]

Why assume that can't be taken into account?

Linda

The "best course of action" in the patient's opinion may be different to her physician's. Many treatments are not cures and a trade-off between suppression of symptoms and unpleasant side-effects has to be made.

E.g., a terminal cancer patient can extend her life with chemotherapy, but the quality of the extended lifespan may be lower.

In general the only person who can decide what trade-off is best is the patient.

 

[Professor Yaffle]

Sure, if the presciption says you need a heart transplant and you have no medical aid or finances, then ultimately the doctor says you are going to die. What other choice do you have, other than an alternative treatment like homeopathy, crystal healing, faith healing or chiropractic.

Well of course there are situations where there are effectively no choices. But many situations aren't like that.

 

[Professor Yaffle]

The "best course of action" in the patient's opinion may be different to her physician's. Many treatments are not cures and a trade-off between suppression of symptoms and unpleasant side-effects has to be made.

E.g., a terminal cancer patient can extend her life with chemotherapy, but the quality of the extended lifespan may be lower.

In general the only person who can decide what trade-off is best is the patient.

http://www.hospicefoundation.org/teleconference/books/lwg2005/sarah.pdf

 

[Skwinty]

Well of course there are situations where there are effectively no choices. But many situations aren't like that.

My point is, discuss your treatment issues with the Doctor and the Doctor should then offer alternative medication which may or may not be as effective, to suit your requirement. I don't think paternalism enters the equation.

 

[fls]

Well if you are not given the information to be able to assess your choices, and the doctor just makes a decision, that is paternalism - right? Or am I misunderstanding the term?

It's not the way people are using the term. The way people are using the term is really "do I have the illusion of making an informed decision or not?"

You don't like being given a prescription without explanation, but a recommendation as to the "best course of action" is okay. If the doctor had explained the medications that could be used and then recommended a particular drug, then you probably would have been okay with the prescription. She/he could even have given you a choice between a couple of different drugs. But pretending that in the course of five minutes you have been given enough information to make a truly informed decision is only an illusion.

The reality seems to matter very little. What seems to matter is the illusion of having the desired degree of information and/or autonomy.

Linda

 

[Professor Yaffle]

My point is, discuss your treatment issues with the Doctor and the Doctor should then offer alternative medication which may or may not be as effective, to suit your requirement. I don't think paternalism enters the equation.

Unless the doctor happens to be very paternalistic ... And I have encountered some like that - they think their priorities for treatment are "correct" and therefore if the patients disagree with them, their priorities are "wrong".