May 17, 2007 - Issue 230

A Patient's Right to "No"
By Timothy R. Cagle
Guest Commentator

What would you do if you had to make a life and death decision in eight minutes, in a field in which you had no education, training or experience? According to Dr. Jerome Groopman, noted oncologist and chief of experimental medicine at Beth Israel Deaconess Medical Center, in Boston, "In today's medical environment, the clinic is a factory. It's a world of eight-minute visits. The mistakes are made in the moment. Doctors draw immediate diagnoses rather than listen and pursue leads."

Most people are afraid to talk to their doctor, even when their health is at stake. Furthermore, many doctors do not encourage questions and keep their answers short and technical, in order to discourage follow-up questioning. This means that most patients undergo treatment without a full and thorough explanation of what their body is about to experience.

The problem with asking questions is that it involves two separate and distinct skills. First, you must have enough familiarity with the subject matter so that you can formulate questions that are cogent and relevant. Second, you must be prepared to follow up your questions with an attitude that will force the doctor to provide an answer that you can understand and comprehend.

Medicine, like many other fields, is a mysterious and frightening territory for most people. Furthermore, doctors are imposing, authoritative figures who are trained to exude self-confidence and make rapid decisions concerning the health and well-being of their patients, often without input from anyone but themselves. Unfortunately, many of their decisions are wrong.

According to Dr. Groopman, "It's impossible to figure out a difficult problem in eight minutes. A doctor has one eye on the clock and one eye on a computer screen as he types notes. The truth is, you can't think well in haste."

When the decision is wrong, it is the patient who pays the price. The only safeguard available to patients, to minimize the damage caused through ignorance, is to ask questions that are pertinent and to demand an answer.

That means that you must do some research on your own before you can ask the right questions. Health care professionals are reluctant to explain basic medical terms because of time constraints. If you know enough about the basics of anatomy and physiology, as it applies to your condition, your questions are more likely to be answered, as the physician is likely to feel that you are an informed patient, worthy of an answer.

Often, asking relevant questions is not enough to make an informed decision. Questions are met with answers that give rise to further questions, as if the physician is deliberately trying to dissuade further inquiries by the patient. The way to avoid such a feeling is to force your doctor to explain the answer to you as if you were a child, refusing to be satisfied until there are no more questions.

Also, the patient needs to remember that each doctor is trained according to his individual specialty. That means that surgeons are trained to cut and internists are trained to prescribe. Often, doctors' decisions are made in compliance with their training.

An article on the front page of the Boston Sunday Globe, dated February 25, 2007, indicates that the problem of lack of informed patients is so widespread that a group of retired physicians is being formed to help fragile and elderly patients who try to navigate the increasingly complex medical system, by accompanying the patients to doctors' offices, hospitals and nursing homes. One of their goals is described as "they hope to help patients get better care by empowering them to ask questions, follow their medication regimes, and get prompt attentions to their problems."

"And, most of all, they plan to be there when no one else is, providing relief for tired caregivers and support for patients without families,"according to Dr. Jonathan Fine, who is leading the effort.

This suggests that the health care system has grown so complex and intimidating that patients now need a retired physician to accompany them to consultations. Apparently, what many school children were taught by religious leaders was incomplete. Some of us were told to follow the Bible when it said "ask and you shall receive."

Unfortunately, we were never told that we only had eight minutes to receive the answers. Or, that our lives could be at stake if we didn't.

Timothy R. Cagle is an assistant professor of law at the Massachusetts School of Law at Andover, and a practicing attorney. He teaches medical malpractice, torts, evidence, and negotiation in the legal context. Click here to contact Mr. Cagle and the Massachusetts School of Law.

 

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