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Health See other Health Articles Title: Patient Choices vs Physician Advice Medscape... A relatively young patient is admitted with invasive, nonresectable carcinoma. He has two options: 1) chemo and radiation or 2) palliative care. Effort is made to ensure the patient is extensively counseled on benefits and risks of initiating or withholding treatment. For me, it's a no-brainer. Option #1 will buy him more time on planet earth; most people enjoy spending time on planet earth. But to my surprise and disappointment, patient chooses option #2. Although I disagree, I respect his decision. Perhaps he was balancing morbidity vs. mortality. Yes, the treatment may extend his life, but at what cost? From a medical perspective, there was a definite need for chemo and radiation to extend his life. But from the patient's perspective, the mortality benefit must have failed to outweigh the morbidity of aggressive treatment. This clash between medical need and patient preference got me thinking. In the last half-century, there has been a major shift in approach to delivery of care. We no longer tower before a patient as the all-knowing doctor ordering what should be done while making little to no effort on educating the patient. Walking through the front door of the hospital was once equivalent to giving modern-day consent to a treatment plan the doctor saw fit given the clinical presentation. Now, we are taught that patient preferences can trump medical expertise, as long as decision-making capacity is intact. In the case above, I cannot help but wonder how things would have been different had he presented to a hospital of paternalistic past. Do paternalistic doctors still have a place in certain aspects of modern medicine fixated on patient-centered care? This gentleman certainly thinks so. What do you all think? Poster Comment: A case where a patient has to accept a doc's decision is when the doc feels he may be hassled for allowing patient to make a choice. Example: Doc will not allow a patient to take the bus to hospital ER but will order an ambulance in a case where doc can't treat AF. Post Comment Private Reply Ignore Thread
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