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

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