New England Journal of Medicine – May 3rd edition– Vol.366, No. 18 leads with an important article entitled Evidence, Preferences, Recommendations–Finding the Right Balance in Patient Care by doctors Quill and Holloway.
It deals with two emerging but potentially conflicting approaches to health care and the doctor/patient relationship–evidence-based medicine and patient preference based medicine. There are times when the two approaches seems in conjunction. There are times when they seem diametrically opposed to each other. This article attempts to bridge the gap.
Essentially it requires the physician to be aware of the latest in evidence-based scientific research and to offer it to the patient and their families. The patient and families must be allowed to air their questions about the risks versus the benefits of what medical science has deemed the "latest" information. They will be forced to explore their own religious, ethical beliefs about illness, recovery, and death. Families will need to work through differences of opinions among themselves and make every effort to offer the physician a consensus approach to such highly charged issues.
The physician must also be open to listening to the patient and families own research on the subject of the disease or condition being treated. We cannot dismiss any of it without addressing the medical basis for their questions. I will often use the phrase, "information is in great abundance on the internet, knowledge is in short supply". It is up to the physician to guide the medical information component of the dialogue. The challenge in bridging this doctor-patient gap is communication.
Doctors speak a different language from patients. I have been shocked at times to hear my colleagues seem literally unable to explain a medical procedure or condition without using other esoteric medical terms. They are literally unable to place themselves in the position of the average person. Physicians need to be more sensitive to how we explain medical conditions without speaking down to our patients or becoming annoyed with their questions.
These are deeply emotional and even spiritual issues. We need to be sensistive to how patients and families react to what we tell them. In many ways the conversation needs to be about the individual patient, their overall physical, cognitive, emotional state of being. Appropriate advice must be individualized and based on the patient's preferences.
We are capable of doing more to patients than we should be doing. This is the challenge of practicing medicine in the 21st century. It is not pure science. There are no mathematical equations or algorithms that will work here. We must face up to the biases and beliefs of both doctor and patient.
This is the art of medicine. It is the best effort of human beings to deal with the realities of sickness and death. It will always be an imperfect task but it is all that we truly have and we should respect the process.