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When Patients & Doctors have Different Priorities


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After discovering that one of his patients had a pre-cancerous polyp, Dr. Michael Kirsch recommended a surgical consult to discuss removal. The man’s answer was one that Dr. Kirsch will never forget.  The patient said he would certainly speak with the surgeon, but not until four months later. Why? Because he didn’t want to miss golf season. Musing about priorities, Dr. Kirsch writes, “We physicians need to remind ourselves that patients make the decisions, even though we often believe that we have the right answers.”


When Desiree Basila was told that her best treatment option for ductal carcinoma in situ in both breasts was a double mastectomy, she refused. Desiree said, “If I die at 75 instead of 95, I think I can live with that. I did not really want to have a double mastectomy.” Reporter Eve Harris says Desiree illustrates “strong evidence that individuals react differently to their treatment choices,” and that she was truly an engaged patient. Desiree researched her condition, obtained a second opinion and discovered a new research trial that would work for her. Desiree concluded, “Every one of us has to decide what will be our quality vs. quantity of life.”


In Does Your Oncologist Care About Your Quality of Life?, Dr. Peter Ubel cites research showing that some oncologists place a higher value on “length of survival more than quality of life when making chemotherapy decisions.” This creates a tricky situation for patients because, as Dr. Ubel says, “Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense?” So, should we trust our doctor’s advice? Ubel says, “Medical recommendations often depend on non-medical judgments…If you ever face an illness forcing you to decide between living long or prospering, make sure it is your values that rule the day, not your doctor’s.”


An Arizona nurse, Amanda Trujillo, was caught in the crossfire between a patient’s and a doctor’s wishes, writes Toni Brayer, M.D., on EverythingHealth. Trujillo provided approved education materials to a patient, and explained the complexity of the liver transplant she was about to receive. The patient, worried about her ability to recover after the procedure, requested a consult with hospice to explore palliative care. This so angered the doctor who planned the surgery that he would not allow his patient to meet with hospice. Trujillo was ultimately fired. Brayer, amazed by this case, said, “In my hospitals, if there was a difference of opinion, an official ethics consult would be obtained and objective professionals would help resolve any conflict. We put the ‘patient first’ and that means whatever helps the patient achieve their life goals is what we support.”

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Inside Health Care posts feature recent news and blog posts from the health care community and are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.

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