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Consider the Pros and Cons of Patient Empowerment

By Richard Woodcock, MD | June 12, 2012

Several recent articles have talked about empowering patients. The ACR has even offered a statement on the topic. And the discussion is an important one to be had, in my opinion.

Here are the two sides of the argument: On one side, patients may not fully understand what is told to them, and may not use that information as expected. Further, the information may only serve to increase anxiety in some. On the other side, more knowledgeable patients can make informed choices about what is or is not needed for them. And patients who understand why things are done, and how much they cost, can make reasonable decisions as to cost-effectiveness.

(MORE: Lessons for Radiology from the Service Industry)

The first argument is criticized as paternalistic; the second as unreasonably utopian. I recall an ethical dilemma posed in medical school that is something like this: If you have a patient going on the trip of a lifetime next week, and you find out they have an important medical condition, do you tell them now (so they can decide to start treatment or choose to do something else), or wait until after they return to tell them (so they can enjoy their trip and not have anxiety).

The truth, as with many things, probably lies somewhere in between. Both sides have some merit, and both sides deserve criticism. To me, the fact is that some patients can mange that data better than others. But it does not have to be one or the other. The patient themselves can decide when they want the information. To me, withholding it from all, because it could be detrimental to a few, is overly restrictive. Perhaps we should offer greater information, and let the patient participate even in deciding what information they need.

Two other aspects of the discussion are important in radiology. First, patients who know test results and recommendations can ask questions about care, and can be sure they can get needed follow-up, or choose not to. This would reduce medical errors such as failure to follow-up on relevant findings.

Second, numerous studies have indicated that when patients feel they have a relationship with their provider and can better trust them, rates of accused malpractice decrease. Communication is important for patients to feel they have been cared for properly. In radiology we don't always have an opportunity to interact with patients, but if patients had more access to our reports, and could communicate with their radiologist personally, it could reduce malpractice claims.

I think more informed patients are better for the system as a whole, and would encourage sharing information, as I have here before. But there may not be a right answer to the issue for everyone and every patient. Each of us need consider carefully the pros and cons on each side.

 

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by Charles Maack | June 15, 2012 1:21 PM EDT

As a prostate cancer advocate, continuing patient for 20 years, and mentor for nearing 16 years, with that 16 years involved in research and deep study of prostate cancer, its treatment, and treatment of the side effects that accompany most treatment options, I have found there are far too many physicians who, having not kept up with their own research and study of this particular cancer, are unaware of new medications as well as new treatment methods that have developed and improved patient outcome, and as a result, shrug off questions of patients/caregivers regarding these new medications and treatment methods. It is obvious to the patient that the physician has no idea what the patient/caregiver is asking. And, unfortunately, these same physicians refuse to accept printout reference material that explains these new procedures; obviously embarassed and unwilling to acknowledge their lack of awareness. On the other hand, we have physicians who are acceptable to being provided information they may not have been aware in view of their daily having to react to day to day treatment requirements. My own Medical Oncologist has been very receptive in wanting to be aware of new events in prostate cancer that, as a generalist Medical Oncologist with an overload of daily patients, makes it more difficult for him to keep up on newer changes in the treatment of specific cancers. My providing him latest info provides him increased knowledge in this special area of treatment; particularly with advanced disease. As a result, we have a close relationship regarding prostate cancer and because of his interest and increased knowledge, is the only local Medical Oncologist to whom I refer patients who must move to this level of treatment. Also, over the years, I have come to be aware and personally know several physicians around the nation who have have become specialists in the treatment of prostate cancer at all levels, and when asked by patients located around the nation where such specialists are located, I can refer them to these physicians. In summary, all physicians should be open to the questions of their patients and patient caregivers, and if they don't know the answers to questions posed, make it a point to admit it and advise the patient that they will look into those questions and get back with them. Nothing is more a turn-off to patients/caregivers than the physician who ignores their pleas for answers and is obviously rushing them out of his office. My advice? Find another.

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