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Why Doctors Hate Science

fls said:
Like what?

Linda
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Perhaps the doctor has no problem swallowing pills herself and would not consider the different shapes, sizes and coatings on the otherwise equivelent options to be of particular relevance unless made aware by her patient that one of the other alternatives would in fact be preferable.
 
fls said:
I'm talking about taking patients concerns and preferences into account (by discussion, not by mind-reading).

Linda
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Well then I don't really see how you are disagreeing with what I have said. What do you find unreasonable/impractical/insulting in my previous posts?
 
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.

(I think - I find Linda a little opaque at times)
 
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.

(I think - I find Linda a little opaque at times)
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But sometimes there is only one option and other times there are more than one. You don't tell a patient you will prescribe antibiotics, pain meds or order surgery that isn't called for just because they want them. OTOH, you do give a patient options when they are equivocal or have a different risk/benefit balance that patient preference is the deciding factor in.

Providers have different levels of paternalism, but there is no black and white, either/or provider as kellyb seems to believe. My impression is that some people resent not being able to find a provider to reinforce their woo beliefs. Some of those people also project the problem as being the provider's desire for control, rather than the fact the person with the unsupportable belief could possibly be wrong.

In rare cases, a provider and patient may indeed just have an issue of power. Certainly I run into this on a rare occasion when my knowledge sets a provider off on the wrong foot. I needed a surgical repair once and the provider I saw insisted there was a different etiology of the problem. She did an inadequate work up and insisted I was wrong about the etiology. Since it was something obvious to me, I went to her office partner who correctly diagnosed the problem, did the repair and I was fine. Again. this is a rare situation.

In most cases, however, patients come in with all sorts of incorrect conclusions about what they have. Not all of them are convinced they are wrong. Then you get resentment (again rare). A patient might believe they are suffering because of the unequal power in the relationship. This is what appears to me to bother kellyb. Ivor is also bothered but it appears to me his gripe is over the unequal power her perceives between himself and the NHS to which he perceives the providers sometimes to be part of the system. I could be wrong about both these assessments. I don't claim to know either of these two well enough to say for certain, but that is the impression I get in the multiple discussions we have on the board.
 
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From Kumar and Clark: Clinical Medicine 6th Ed.

Box 1.9 Qualities leading to good relationships

Primary care physicians (who have never been sued):

* orientated patients to the process of the visit, e.g. introductory comments: 'We are going to do this first and then go on to that'
* used facilitative comments
* asked patients their opinion* used active listening* used humour and laughter
* conducted slightly longer visits (18 versus 15 minutes).
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Professor Yaffle said:
Maybe I am just relying on my own experience a little too much here, but I HAVE experienced doctors who have basically ignored my experiences and priorities and just gone on and prescribed what they wanted to prescribe. Thats the attitude I don't like and what I am thinking of when I think of paternalism.
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It can happen, but I contend it is very rare. Selective memory would likely mean you remember those instances more than the unremarkable doctor visits.
 
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For centuries, physicians have been allowed to interfere and overrule patient’s preferences with the aim of securing patient benefit or preventing harm. With the radical rise in emphasis on individual control and freedom, medical paternalism no longer receives unquestioned acceptance by society as the dominant mode for decision-making in health care. But neither is a decision-making approach based on absolute patient autonomy a satisfactory one. A more ethical and effective approach is to enhance a patient’s autonomy by advocating a medical beneficence that incorporates patients’ values and perspectives. This can be achieved through a model for shared decision making, acknowledging that though the final choices reside ultimately in patients, only through physician beneficence can the patient be empowered to make meaningful decisions that serve them best. For such a model to function effectively, the restoration of trust in doctor-patient relationship and the adoption of patient-centred communication are both crucial.​
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http://www.sma.org.sg/smj/4303/4303sf3.pdf
 
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When I was in hospital having my first baby, I encountered several doctors. Of those I was able to form an opinion about (I'll exclude the doctor in charge of getting baby out safely as there wasn't much time for a chat), not one of them listened to me or took into account anything I said to them. I think the old style paternal attitude is still very much in evidence. As I say, it is a minority, but its definitely not a vanishingly small one.
 
History taking is one of the "art" forms of medicine. Yes I know anyone can ask questions, but it is so much more than that.

You have a finite time period to get your information. I agree that open ended questions work, and they garnish a fair bit of info, and they are one of the pieces to the puzzle.

However, when working on a time line, I find Selective questioning of relevant issues much better.

You start off broad, and work your way into the narrow.

Abdominal pain? How long? What part of your abdomen? What makes it worse? What relieves it? Other symptoms such as Nausea/Vomitting, Change to your bowel habits, fever, etc?

Ah, so it has been there for 3-4 weeks, on the right upper side, and greasy food makes it much worse?

Physical Exam reveal distinct RUQ tenderness.

CBC, LFTs, Amylase, and an Abd u/s for starters...will see from there.

an easy example I know, but you get the picture?

Now the above is more of an ER Doc history.

In the clinic, developing a doctor patient relationship, you use more open ended questions, ask them what they think it is, what they were hoping would happen when they came to see you (did they want medicine, reassurance, a sounding board, all of the above), etc...

I find different methods for different settings works best for me.

TAM:)
 
skeptigirl said:
And just what % of providers do you think do not ask for patient's opinions or use active listening?

<snip>
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At least one it seems:

Ivor is also bothered but it appears to me his gripe is over the unequal power her perceives between himself and the NHS to which he perceives the providers sometimes to be part of the system. I could be wrong about both these assessments. I don't claim to know either of these two well enough to say for certain, but that is the impression I get in the multiple discussions we have on the board.
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:boggled:

IIRC, the average time between a patient starting to explain why they are seeing their doctor and the doctor interrupting them is 18 seconds, and less than a quarter of patients complete their opening statement.

Here we go:

http://books.google.co.uk/books?id=...oPyGCw&sa=X&oi=book_result&resnum=1&ct=result
 
How about an anaesthetist who, when you report the classic symptoms of post dural puncture headache to a midwife (who recognises them as such) doesn't even bother to come to speak to you, but just sends a message back saying she is absolutely sure that the epidural was fine.
 
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Professor Yaffle said:
How about an anaesthetist who, when you report the classic symptoms of post dural puncture to a midwife (who recognises them as such) doesn't even bother to come to speak to you, but just sends a message back saying she is absolutely sure that the epidural was fine.
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Now, now. Doctor knows best.:)
 
Ivor the Engineer said:
At least one it seems:



:boggled:

IIRC, the average time between a patient starting to explain why they are seeing their doctor and the doctor interrupting them is 18 seconds, and less than a quarter of patients complete their opening statement.

Here we go:

http://books.google.co.uk/books?id=...oPyGCw&sa=X&oi=book_result&resnum=1&ct=result
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Encouraging a patient to provide relevant information as opposed to irrelevant story telling has zero to do with getting the patient's opinions.

This is a perfect example of your inability to connect the dots. You don't have the skills to get a patient history so you draw false conclusions about a description of one.
 
skeptigirl said:
Encouraging a patient to provide relevant information as opposed to irrelevant story telling has zero to do with getting the patient's opinions.

This is a perfect example of your inability to connect the dots. You don't have the skills to get a patient history so you draw false conclusions about a description of one.
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Its seemed to me that Ivor was drawing similar conclusions to the author of the book. Was the author also drawing false conclusions? Did you actually read anything of the link he provided?
 
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Professor Yaffle said:
Maybe I am just relying on my own experience a little too much here, but I HAVE experienced doctors who have basically ignored my experiences and priorities and just gone on and prescribed what they wanted to prescribe. Thats the attitude I don't like and what I am thinking of when I think of paternalism.
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I understand that, and of course nobody likes it. Hence the need for the illusion.

Linda
 
Ivor the Engineer said:
Perhaps the doctor has no problem swallowing pills herself and would not consider the different shapes, sizes and coatings on the otherwise equivelent options to be of particular relevance unless made aware by her patient that one of the other alternatives would in fact be preferable.
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Wouldn't it be simpler to just tell the doctor that?

Linda
 
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