I read an interesting, if infuriating, opinion piece this morning. Dr. Barron Lerner wrote about physicians discussing sensitive topics such as weight and mental health with their patients. Lerner feels that asking permission before discussing these topics–“Would you like information on how to cut your risk for diabetes and high blood pressure?”–is bringing political correctness into the doctor’s office. To his credit, he does admit that this is a paternalistic attitude.
While I have never been the recipient of a lecture from a physician about my health, I feel as if receiving information in that manner might not lead to behavioral change. At this point, no one is unaware that there is a correlation between obesity (or binge drinking, or untreated mental illness, or unprotected sex, the list goes on) and undesirable health outcomes. The patient might not be ready to hear that message, or might need to feel as if they’re an active participant in a discussion instead of a passive recipient of a lecture.
It is frustrating to have a loved one who engages in risky behavior and cannot be begged or cajoled to stop. And it must be frustrating to be a physician who treats patients who cannot be induced to give up risky behavior. But it is also frustrating to be a patient who feels as if their doctor is not listening to or refusing to treat their health concerns. And sometimes it’s actually dangerous, as in the recent case of a woman who was refused treatment after her IUD dislodged.
A paternalistic doctor-knows-best attitude also seems old-fashioned at a time when patients have resources to empower themselves. A coworker of mine used WebMD to correctly diagnose her gallbladder problem, but was turned away without an ultrasound or CAT scan because her doctor disagreed. It eventually turned into pancreatitis. I had the experience of a doctor thrusting a sheet on 1200 calorie diets when I asked about weight loss. The portly physician told me that I should eat no more than 1200 calories per day. I eventually lost weight using MyFitnessPal, which assigned me several hundred more calories per day based on my young age and high activity level.
Patients do best when they are given some degree of control over a two-way discussion. It’s disheartening for Lerner’s patients that he doesn’t view it that way.
(Busy day today, so no time to find links for my usual Cozy Things of the Day. See you Monday!)