Arrogance Is Bliss (for some)

Physicians in the U.S. are trained to reassure patients by "taking charge," with a demeanor intended to demonstrate that they are sure of themselves. They give patients orders, they present limited options, they decide what will be done and inform the patient of what will happen (or, in many cases, of what has already happened). This may in fact be reassuring to some patients, but for many others, it creates an atmosphere of coercion and suboptimal care. Patients have the right to refuse care, or to selectively reject treatments while accepting others. However, they are often unaware of their rights, or are unwilling to go through the psychological stress of insisting on their own preferences for treatment.

For physicians in daily practice, arrogance may indeed be bliss. Every time they browbeat a patient into accepting an exam or test that the patient would otherwise refuse, they gain both monetarily and in liability protection. Courts have repeatedly awarded large sums to patients for tests not done, or procedures never performed, that in the court's eyes might have prevented injury to the patient. However, courts do not generally hand out malpractice awards for coercing patients into needless exams or tests. Therefore, the physician is strongly rewarded for disregarding patients' wishes and increasing medical costs to everyone.

Combine this mode of behavior with the practice-based model of care, and we move from annoyance and expense into a much more worrisome realm. Physicians are trained to value autonomy in their practice above conformance with the recommendations of researchers. Research on medical treatments is often disregarded in favor of the anecdotal experience of the physician's own patients. For example, a physician may be reluctant to abandon routine episiotomy, a surgery that has exhaustively been demonstrated as harmful in the medical literature, for the sole reason that they are accustomed to performing the procedure and believe their own patients benefited. Any statistician or scientist can explain why anecdotal evidence is the worst possible data source on which to base decisions, yet this is precisely what physicians are taught to value. Medical procedures that have been shown to be detrimental are therefore continued, and patients are not only kept in the dark about this fact but are also actively coerced into accepting these outdated treatments at their own risk and expense.

Patients should not have to fight to have their decision-making rights respected. Physicians ought to inform patients of up-to-date recommendations on testing and treatment based on research. We can make progress in these directions by insisting on tort reform that limits malpractice awards and by changing our medical education system to emphasize respect for scientific data and for the patient's ultimate authority in medical decisions. Until these changes are made, it is up to each of us to take charge of our medical care to be sure we are not being harmed by outdated practices or robbed blind by unnecessary procedures.

-- SorrowsDaughter - 18 Feb 2007