Service of “You Choose”
March 9th, 2023
Categories: Choice, Decisions, Doctors, Insurance, Interior Design, Lawsuit
A friend was a talented interior designer. She would come to our home with a stack of fabric samples all of which were great choices. “Big deal,” you think. When it came to home décor, my husband and I had very different likes: He leaned to the formal and elaborate. I prefer the opposite. Yet she’d surmount that hurdle with ease and arrive with perfect color and pattern pitches for the pieces that needed upholstering. And we’d happily choose the finalists and the winner.
But you don’t expect that approach at a doctor’s office. Seems it’s a popular tactic these days. A few years ago my doctor, knowing I was going to visit a surgeon next, said, “I hope to goodness he doesn’t give you choices.” Sounded strange to me: I either needed a procedure or I didn’t.
Here are two examples in which the patient was asked to decide. In one, it involved which operation of several needed should take place first. The surgeon told the patient to choose. In the other, the same words were uttered about two powerful drugs. Neither patient is a physician. Without the background, how in the Sam Hill can a patient make the most judicious choice?
Had we made a bad selection of fabric the only damage would have been to our wallet. But a patient choosing door number one when it should have been door number three could be seriously up the creek.
There are exceptions. My dentist has warned me that a conservative approach and tricky fix for a dental crisis might not work and I’ve chosen to give it a whirl. Dr. Alan Jaslove is a spectacularly talented dentist and if anyone can carry out a challenging procedure, he can. I’m braced to tolerate the more costly alternative if he can’t pull off the difficult, less expensive one—he makes clear the risks.
And obviously there are countless examples of patients who refuse to take medicine the side effects of which are worse than the disease or who stop physical therapy or decline to follow suggested diets. But sometimes we need guidance from an expert.
I’m guessing that passing the buck to the patient approach is influenced by insurance companies in a litigious society. Can’t you hear it: Doctor to the judge: “Well Jeanne opted to do thus and such. I gave her the choice. I had nothing to do with her decision.”
Has a doctor—or anyone else, such as a builder–given you a choice you weren’t prepared or educated to make? Are the medicine and operation examples I described one-offs? Why do you think some doctors leave crucial decisions up to the patient without recommendation?
Tags: Dr. Alan Jaslove
JEANNE, ALL PART OF TREND OF SOME YEARS AGO WHEN WE STARTED PRACTICE—THE PATIENT HAS TO BE HIS/HER OWN BEST ADVOCATE IN MAKING DECISIONS.
TC,
Armed with facts a patient might make a decision but without them–or the benefit of experience–the patient is up the creek. You read stuff in the newspaper and online that’s enough to scare you silly. And you don’t know if any of it is accurate. Your friends share what they know–anecdotal at best. One doctor said to me, “If you were my mother….” I’ll take it! [One hopes he liked his mom.]
Sorry, but if one of my doctors asked me to make such choices, I would find another specialist.
Linda on Facebook: Only time, at least so far, I was asked to make a choice was what kind of lens I wanted in a cataract surgery (ie, distance or reading). But I do know of patients with far worse illnesses being asked to agree to or choose one treatment over another due to severity of treatment, more difficult recovery, unknown outcome, etc.
ASK,
I thought it was a one-off when one acquaintance told me her story but when two heard the same words, in different specialties…I had to share my reaction which is YIKES.
Linda,
I find no fault with that question. A doctor shouldn’t make that decision for you anymore than he/she would about a change in eye color [if that’s possible through surgery]. But had the doctor said, “Do you think you need, or do you want cataract surgery, yes or no, you decide,” I’d be concerned.
When a doctor/dentist offers a choice it’s because it’s expected that either procedure will work but he wants your input in hopes of achieving the best result. On such occasions, my approach is to request a presentation along with a full description of the positive and negative aspects involved.
It’s unlikely that a doctor is interested in a patient’s medical evaluation – but rather a personal one which may reveal the best way in which to proceed.
Lucrezia,
My dentist volunteers the options and risks. The you choose examples in the post are jaw-dropping. Why mention two meds and not share a preference? A memorable moment at my first PR job happened when my boss handed me my first memo to the client and said it was good at laying out all the strategies but it was missing a crucial point: which do I recommend? Any consultant owes a client, customer or patient that. What would they choose for themselves?
The time for asking for a recommendation is after one has heard, digested and mulled over the options. No sense giving choices if one plans to foist “the best one” on the patient before he has time to consider.
I as apalled by being asked by a specialist which of two medicines I would prefer. The choice was between one which was prescribed and that I was taking and a new one I knew nothing about. I think that it is not my job as a patient to make such a determination. I essentailly lost all faith in the doctor and her judgement. I am not sure what the thinking or motivation behind this mode of interacting is, whether for insurance or customer satisfaction, but I find it very disturbing. Medical care every day becomes more remote, detached and inadequate. I am also tired of hearing attribution of every deficiency of care and attention attributed to lack of staff able to assist all the”customers”.