On Patient Autonomy

Recently, I was involved in a discussion on an e mail list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term "patient" engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like "client" or something similar.

Having participated in the preparation and dissemination of the white paper on e patients, I don't see the need for 'factions' or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated, "This is a big tent, with room for all". I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor/patient relationship that I have with them. They make the choice to enter into, or to activate or deactivate the relationship with me. They may ignore my input, seek a second opinion, or fire me and seek the care of another physician at any time. They truly are in control, in that sense. The only thing I have control over and am responsible for is trying to provide the best advice or consultation that I can.

They use the internet for education about their health issues and, increasingly, to join patient communities for problem solving, support, information and research. Some even seek the input or advice of professionals they have never met through online services like eDocAmerica. Sometimes, they may find that information they get on the internet or from other patients demonstrates that what they received from me was in error. So much the better, if they can use networking to improve the quality of the information at their disposal, we will have a healthier, more efficient health system.

The less they "need me" the better I like it but I continue to hope, in their best interest, that they are exerting their autonomy by making good choices and achieving optimum outcomes. Just like I don't expect to achieve an optimum outcome with a complicated home repair without a consultant such as an electrician, or to be able to fix my car without a mechanic, or achieve a legal victory without a lawyer, most patients won't achieve optimum medical or health outcomes without a medical consultant. And, has also been pointed out, some outcomes absolutely require a physician (e.g. surgery, intensive care, chemotherapy, radiation, etc).

And, do these consultants ever make errors, be they of commission or omission, you bet! That is why the partnership is important. As good or as meticulous as a doctor might be, he is inevitably going to miss things that the patient and their caregivers are in the best position to recognize and correct. They may also be, by virtue of networking and patient communities such as ACOR and others, privy to information that is more current or more relevant than what they may receive by their own physicians. We, as physicians should not worry about, or be threatened by this, but should embrace it as the best chance for the patient to achieve optimum outcomes.