Despite the fact that so much incorrect, and misleading information exists today in so many aspects of American society, makes it precisely the reason why the medical profession must continue to lead the way in the provision of the best objective information, and facts when providing the expert care that all people deserve, and expect.
So, it was enlightening to read the New England Journal of Medicine’s article, “From the Eyeball Test to the Algorithm— Clinical Decision Making in Surgery”, C.E. Brinkley, et al, October 6, 2022.
The article begins with “Good surgeons know how to operate; better surgeons know when to operate. But only the wisest surgeons know when not to operate”. This is true in the surgical “world”, and can be extrapolated to all aspects of medical care. This means that all medical practitioners need to achieve the highest level of understanding of their trade. But, the article goes further by stating that they must then explain and communicate all the possible outcomes of that treatment objectively to the patient, so that the patient can compare them with their own desired outcomes. To put it another way, the medical provider must not use their own set of outcomes for the patient, but rather those of the patient. Only then is the final level of true and objective information conveyed.
The article discusses the issues that confront surgeons, and their patients when making decisions regarding surgery. Surgeons are motivated by their intentions “to do good”, and “avoid harm“. But, since it is not their bodies, but rather their patients, surgeons have their own subjective biases when it comes to medical decision making. This includes the resultant physical and emotional conditions the patients will ultimately bare. Their eventual quality of life.
Evidence exists that the surgeon’s own subjective comparison of the patient’s quality of life, with the patient’s own understanding of their own quality of life “are wrong more often than not”, And, that surgery should be offered when medically necessary, and when the patients are aware of all the outcomes, especially including their understanding of how they will feel, and how their lives might be different after the surgery.
That this process is generalizable to the practice of all of medicine is clear.
The goal is to provide the best medical information, that is as “accurate and objective as possible”, with the associated risks, and the patient’s own set of values of the outcome to themselves, including the resultant quality of life they will experience.
It is the responsibility of all medical providers, to practice in this fashion, and it must be objective, complete, and provided in simple non-medical language that patients can understand.
Only when we get back to the basics, and give patients a direct, and focused “picture” of what they will experience during, and after the treatment is rendered have we done our job correctly.
Physician Forum has always believed that the Medical profession has a moral code to patients, and society. Hopefully we can be a guidepost to others in these difficult times.
Peace and stay safe.