Monday, 22 February 2016

The shared clinical decision is a two way street

Peter Ubel is a doctor specialized in the field of bioethics and the research of human behaviour. As he confesses in his blog, he likes to explore the dialectic of rational and irrational forces that affect the people’s health, their happiness and the way society works.

I attached a promotional video for his book "Critical Decisions" which delves into the realm of shared clinical decisions. "The attitude of people to the risk of contracting a disease, argues Dr. Ubel in this video, does not depend on whether they understand the numbers explained to them, but on how they interpret them and, thus, very often important clinical decisions are taken based on the subtlety of perception." For example, many patients are more inclined to opt for an intervention with a 90% survival rate than for one with a 10% mortality rate. Given a risk, fear always wins over reason.

With the advent of scientific medicine, the doctor took the pedestal of therapeutic efficacy, and now, since he had to take a step down due to the patient’s newly acquired decision rights, he doesn’t quite know how to act. Not surprisingly the formation process of a doctor is a long desensitization to the pain and illness, but instead the actual medical practice almost always moves in the universe of emotions. "Lost in Translation," says Dr. Ubel, to summarize the variety of cases discussed in the book. "Many doctors are not concerned as much with what patients really think whilst the patients return the same attitude by showing little interest in the doctor’s often incomprehensible jargon."

Those who think the shared clinical decision is a technical or even legal issue (a rights issue) are mistaken. It’s a question of emotions and there is no way of managing it but to place oneself in the other’s shoes, even for a moment, and understand that when a patient receives bad news, the last thing he needs is a storm of numbers and probabilities. Sometimes he only wants a little time and understanding, and the doctor who doesn’t know how to recognize this need does a disservice to medical profession.

In summary, this is an analytical work for lovers of good medical practice.

Jordi Varela 

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