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From the perspective of a healthcare provider: First, every patient has very valuable knowledge for their physician: their symptoms. There's absolutely no subs

by wux 9y ago

From the perspective of a healthcare provider: First, every patient has very valuable knowledge for their physician: their symptoms. There's absolutely no substitute, and as a patient you are the definitive source for that information and the undisputed expert. Second, I do find that it's very often helpful when my patients have done some reading about their condition. It shows engagement in their care and is a great way to jumpstart the conversation. And it gives me a good idea of the level of insight into their disease and the best way to approach the patient education part of my task. However, to be clear, it is my responsibility ethically and legally to have the expertise to treat you and to apply that expertise in making an assessment and plan. If I find that I don't have the expertise that's necessary, I should be consulting with or referring you to another medical professional who does. It's your right to have your physician's thinking explained to you and to agree or disagree with the plan, and if you think your physician is wrong, it's also your right to ask for a second opinion. However, it is never ethical for me to rely on your medical judgment in formulating a plan. So, please don't take it the wrong way when your physician limits the amount of research he or she will hear from you. I stick to strict boundaries even with patients who are physicians themselves--even when they are significantly more senior and experienced. And when I'm the patient, I try my hardest to describe only my symptoms, confident that I will receive better care that way.

mistermann 9y ago
What bothers me about this comment, and seems entirely consistent with my experience with doctors, is the apparent lack of recognition of the notion of unknown unknowns. > However, to be clear, it is my responsibility ethically and legally to have the expertise to treat you and to apply that expertise in making an assessment and plan. If I find that I don't have the expertise that's necessary, I should be consulting with or referring you to another medical professional who does. It may be your "ethical and legal responsibility", but how is a doctor that sees patients 8 hours a day supposed to keep up with new discoveries, and how is the perfectly reasonable scenario of not knowing you don't know something supposed to be resolved for the good of the patient? > However, it is never ethical for me to rely on your medical judgment in formulating a plan. Is it ethical to have an ego so large that you literally refuse to listen when your patient is trying to inform you of something that you apparently have no knowledge of (arrogantly interpreting this as the patient making a "medical judgement" and patting them on the head for your incorrect assumption of their intellectual arrogance)? This is why I am of the opinion that the broad medical establishment needs to be reminded that they are not omniscient, through no fault of their own.
- wux 9y ago
  > It may be your "ethical and legal responsibility", but how is a doctor that sees patients 8 hours a day supposed to keep up with new discoveries, and how is the perfectly reasonable scenario of not knowing you don't know something supposed to be resolved for the good of the patient? Continuing medical education is now a requirement of continued licensure. All doctors are legally responsible for keeping up with new developments and offering treatment that meets the modern standard of care. If I am unwilling to use some of the other sixteen hours of the day to brush up (in the unlikely scenario that I have only eight hours a day of patient responsibilities), I am required to leave the profession. Patients do not tolerate care that’s compromised by unknown unknowns–unless it’s truly unknown to all of medical science–and the medical and legal professions do not tolerate it either. Let me ask you this: what are you hoping to achieve when you “try to inform” your doctor? Is it to share your personal preferences and values? Your doctor should definitely take those into account. Is it to share your experience of the illness? You’re right to expect an empathetic ear. Is it to add to your doctor’s fund of knowledge so as to change his or her assessment of your condition or the treatment that you are offered? This scenario is ethically impermissible for your doctor; it has nothing to do with ego.
  - mistermann 9y ago
    The key phrase being "that meets the modern standard of care", as opposed to most current available knowledge. Aka "good enough". And just as there's no realistic way for doctors to stay completely current (I expect specialists in a specific field would often have trouble staying current even there), I'd have to see some pretty extraordinary proof to get me to believe doctors are confirmed to be comprehensively up to date on all "modern standard of care" medical knowledge. > Patients do not tolerate care that’s compromised by unknown unknowns–unless it’s truly unknown to all of medical science–and the medical and legal professions do not tolerate it either. Good lord, if one is connected to the internet or reads the newspaper this is so obviously false it is shocking someone would make the claim. And in Canada, you take what little medical care you get and you like it. Luckily, the vast majority of patients are utterly uninformed, so this theory would rarely be put to the test. > Is it to add to your doctor’s fund of knowledge so as to change his or her assessment of your condition or the treatment that you are offered? This scenario is ethically impermissible for your doctor; it has nothing to do with ego. Wow. So, you literally can't even believe a scenario can possibly exist where any patient might be aware of studies related to a particular ailment, and that upon informing the doctor of it's existence, the doctor could then go read the study for him/herself and incorporate the knowledge into their practice? Please tell me this is a misunderstanding between us. edit: fixed a backwards phrase

by wux 9y ago

mistermann 9y ago

What bothers me about this comment, and seems entirely consistent with my experience with doctors, is the apparent lack of recognition of the notion of unknown unknowns. > However, to be clear, it is my responsibility ethically and legally to have the expertise to treat you and to apply that expertise in making an assessment and plan. If I find that I don't have the expertise that's necessary, I should be consulting with or referring you to another medical professional who does. It may be your "ethical and legal responsibility", but how is a doctor that sees patients 8 hours a day supposed to keep up with new discoveries, and how is the perfectly reasonable scenario of not knowing you don't know something supposed to be resolved for the good of the patient? > However, it is never ethical for me to rely on your medical judgment in formulating a plan. Is it ethical to have an ego so large that you literally refuse to listen when your patient is trying to inform you of something that you apparently have no knowledge of (arrogantly interpreting this as the patient making a "medical judgement" and patting them on the head for your incorrect assumption of their intellectual arrogance)? This is why I am of the opinion that the broad medical establishment needs to be reminded that they are not omniscient, through no fault of their own.

wux 9y ago
> It may be your "ethical and legal responsibility", but how is a doctor that sees patients 8 hours a day supposed to keep up with new discoveries, and how is the perfectly reasonable scenario of not knowing you don't know something supposed to be resolved for the good of the patient? Continuing medical education is now a requirement of continued licensure. All doctors are legally responsible for keeping up with new developments and offering treatment that meets the modern standard of care. If I am unwilling to use some of the other sixteen hours of the day to brush up (in the unlikely scenario that I have only eight hours a day of patient responsibilities), I am required to leave the profession. Patients do not tolerate care that’s compromised by unknown unknowns–unless it’s truly unknown to all of medical science–and the medical and legal professions do not tolerate it either. Let me ask you this: what are you hoping to achieve when you “try to inform” your doctor? Is it to share your personal preferences and values? Your doctor should definitely take those into account. Is it to share your experience of the illness? You’re right to expect an empathetic ear. Is it to add to your doctor’s fund of knowledge so as to change his or her assessment of your condition or the treatment that you are offered? This scenario is ethically impermissible for your doctor; it has nothing to do with ego.
- mistermann 9y ago
  The key phrase being "that meets the modern standard of care", as opposed to most current available knowledge. Aka "good enough". And just as there's no realistic way for doctors to stay completely current (I expect specialists in a specific field would often have trouble staying current even there), I'd have to see some pretty extraordinary proof to get me to believe doctors are confirmed to be comprehensively up to date on all "modern standard of care" medical knowledge. > Patients do not tolerate care that’s compromised by unknown unknowns–unless it’s truly unknown to all of medical science–and the medical and legal professions do not tolerate it either. Good lord, if one is connected to the internet or reads the newspaper this is so obviously false it is shocking someone would make the claim. And in Canada, you take what little medical care you get and you like it. Luckily, the vast majority of patients are utterly uninformed, so this theory would rarely be put to the test. > Is it to add to your doctor’s fund of knowledge so as to change his or her assessment of your condition or the treatment that you are offered? This scenario is ethically impermissible for your doctor; it has nothing to do with ego. Wow. So, you literally can't even believe a scenario can possibly exist where any patient might be aware of studies related to a particular ailment, and that upon informing the doctor of it's existence, the doctor could then go read the study for him/herself and incorporate the knowledge into their practice? Please tell me this is a misunderstanding between us. edit: fixed a backwards phrase