Friday, January 22, 2016

The Successful Patient: Ten Commandments for Patient-Centered Treatment

Medicine is a service industry.  We don't like to think of it as an "industry," but if you consider the definition of industry, i.e. "a distinct group of productive enterprises," it fits. Every enterprise in the medicine industry -- hospitals, radiologists, surgeons -- provides a service.  Doctors offer their knowledge and expertise to people in order to help them take care of their bodies whether in sickness or in health.

When you are looking for a new doctor, do you know what to expect from her?  Do you know what to expect from your current doctor?  Patients need to know what to expect from their doctors in order to be able to get the most out of the services they provide.  The British Journal of General Practice recently published the "Ten Commandments for patient-centred treatment" (British spellings) assembled by a team of doctors from the U.K. and Canada.  I'd like to make my own comments on these particular commandments.

The Commandments

1.  Thou shalt have no aim except to help patients, according to the goals they wish to achieve.
When I walk into a doctor's exam room and I'm sick, the first thing I want is for the doctor to diagnose the illness.  This requires from me that I communicate well what my symptoms are, how long I've been sick, etc.  In other words, I expect the doctor to ask me lots of questions.  If a doctor doesn't, then I'd question whether he wanted to help me or not.  Once a diagnosis has been established, then I expect the doctor to be able to treat me so that I will get better and be able to return to my regular life.  Some illnesses, however, are incurable, and with these, it's important to have a good relationship with your doctor, open communication, and compassion.  I expect my doctor to do the best he can to help me, and he expects me to do the best I can to partner with him by following his instructions and letting him know how the treatment is working.

Beware of doctors who speak in absolute terms when proposing a treatment, or telling you in an ominous or threatening tone of voice that if you don't do what they say, you'll die.  At that point, you have the right to a second opinion.

2.  Thou shalt always seek knowledge of the benefits, harms, and costs of treatment, and share this knowledge at all times.
I expect my doctor to be honest with me about the risks of treatment as well as the benefits.  He needs to be willing to work with my insurance company if prior authorization is required by them.  And I expect my doctor to be more than willing to answer ALL my questions -- to take the stance that there are no stupid questions asked by patients.  I expect my doctor to be willing and proactive in consulting with other doctors I see regarding my condition in order not to prescribe a treatment that could interfere in some way with their treatments of me.

3.  Thou shalt, if all else fails or if the evidence is lacking, happily consider watchful waiting as an appropriate course of action.
 What is watchful waiting?  I would expect my doctor to explain the pros and cons of taking this approach.  It involves no treatment.  I expect my doctor to also explain HOW he'll be watching my condition and what are the criteria for shifting to active treatment.

4.  Thou shalt honor balanced sources of knowledge, but thou shalt keep thyself from all who may seek to deceive thee.
I expect my doctor to stay current on research, treatments and anything else involving my illness(es).  I want him to be my first choice source of information, not the internet.  I expect him to be able to explain to me positive and negatives and their impact on me as a patient.  In other words, I expect him to be honest with me, to do what he says he'll do, and be trustworthy.

5.  Thou shalt treat according to the level of risk and not to level of risk factor.
I expect my doctor to understand the difference.  I also expect him to be able to tell me how the risks has played out among other patients, especially if there are conditions to the risk.

6.  Thou shalt not bow down to treatment targets designed by committees, for these are but graven images.
I expect my doctor to focus on treatment targets for MY specific case.  I do expect him to consult others, and especially to work with my medical team in establishing treatments and targets for those treatments so that everyone, including me, is on the same page, and no one ends up hurting me.  It's important that my doctor respects his patients as individuals.

7.  Honor thy older patients, for although they often have the highest risk, they may also have the highest risk of harm from treatment.
I expect my doctor to monitor my treatment in order to be able to stop it if it is harming me.  That is true for a patient of any age.  I expect my doctor to treat all his patients with respect no matter their ages.

8.  Thou shalt stop any treatment that is not of clear benefit and regularly reassess the need for all treatments and tests.
I expect my doctor to be open to my questions about benefits of treatments and especially what will happen over the long term.  It is my job to ask questions, especially about reassessing treatments and asking for something else.

9.  Thou shalt diligently try to find the best treatment for the individual, because different treatments work for different people.
I expect my doctor to look at me as an individual and not a disease.  At the same time, I need to accept that medicine is an imperfect science, and often there's some guesswork and trial by error involved in finding the best treatments.  

10. Thou shalt seek to use as few drugs as possible.
I expect my doctor to be open to not prescribing drugs if there are alternative possibilities such as diet, acupuncture, etc.  I expect my doctor to also be aware of possible alternative treatments for my condition and be willing to talk with me about them.  I think it's very true: every thing we put into our bodies, no matter how benign we think they are, still interact with our bodies and their biochemistry.  We need healthy food, not junk food.  We need discerning, targeted treatments, not carpet bombing of disease.

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