DOCTOR-PATIENT RELATIONS
As consumer values make their way into the medical world, a change
in the doctor-patient relationship is inevitable.
Patients today want reasons, insists Miles Shore, M.D., a Harvard
professor of psychiatry. But they still need to look up to their doctor
to get well. It's time, he says, for doctors to trade in their
authoritarian ways for a more authoritative approach. The former talks in
absolutes, the latter in probabilities.
"Patients want to work in a partnership with physicians rather than
be told what to do," says Shore. "People want a doctor who will explain
the diagnosis and alternative treatments."
Take, for example, the prevention of osteoporosis with estrogen
replacement therapy in postmenopausal women. The hormone has side effects
and potential links to cancer. "Doctors who practice authoritative
medicine will tell women the pros and cons of the therapy and let each
decide for herself."
AUTHORITARIAN
You have a heart problem and high cholesterol. Take these
pills
and your cholesterol level will go down.
AUTHORITATIVE
You have a heart problem and high cholesterol. You can take
pills,
which have side effects that I'll tell you about or you can
eat
less fat and exercise more. It's up to you.
AUTHORITARIAN
Because you're over 35, your risk of having a baby with
chromosome
problems is high; you must have an amniocentesis.
AUTHORITATIVE
The risk of having a chid with a chromosomal abnormality at
your
age is one in 192. An amniocentesis will tell you if your baby
is
afflicted. But the risk of losing a pregnancy through a
botched
amniocentesis is one in 300 or 800, depending on whose research
you
refer to. Do you want to take the test and are you prepared for
the
decisions that may accompany bad results?
AUTHORITARIAN
We can see on the MRI that you have a growth on your skull. It
must
be removed.
AUTHORITATIVE
We can see on the MRI that you have a growth on your skull. We
can
do a biopsy to see if it is malignant and if so, we will remove
it
or, if it's benign, we can dose it up or remove it; it's
your
choice.
ILLUSTRATION
Tags:
absolutes,
cancer doctors,
cholesterol level,
chromosomal abnormality,
chromosome,
communication,
consumer values,
dialogue,
doctor,
doctor who,
estrogen replacement therapy,
harvard professor,
having a baby,
heart problem,
high cholesterol,
listening,
medical world,
patient,
patient relations,
postmenopausal women,
prevention of osteoporosis,
probabilities,
pros and cons
