Shared Decision Making Between Patients and Doctors Improves Outcomes

PaternalismHenry David Thoreau said: “(if) a man was coming to my house with the conscious design of doing me good, I should run for my life.”

When I was in medical school 30 years ago, one of the doctoring styles most looked down on was that called paternalism. Paternalism in medicine can be defined as the practice by doctors (those in positions of authority) of restricting the freedom and responsibilities of patients supposedly for their own good. It is a “Doctor knows best” approach that denies the patient decision making rights regarding their health care.

I have been horrified in the last few years to see my profession completely turn it’s back on patients and adopt the despicable practice of paternalism when it comes to vaccines. The entire concept of informed consent seems to have been thrown out the window when it comes to vaccines. All doctors are saying now is, “it’s time to do your vaccines,” as they hand patients a CDC glossy that literally glosses over the side effects and negative effects of vaccines while magnifying the horrors of the diseases the vaccine might protect against. The paternalistic doctor would then make some disparaging comment about parents who don’t care enough about their children to decline such a life saving procedure as the vaccine in question. Faced with this, most buckle. Score one for the “doctors know best” and the pharmaceutical company that has masterfully manipulated the data to magnify the benefits of their vaccines while carefully designing studies not to show the side effects that often come years later, or are so rare that they are missed in the small studies.

With paternalism there is a conflict of two important values:

  1. The value we place on the freedom of persons to make their own choices about how they will lead their lives.
  2. The value we place on promoting and protecting the well being of others.


I happen to like helmet laws and seat belt laws. They could be considered paternalistic as it is the state mandating a behavior that really is for your own good. The reason I’m OK with them is that I really can’t find any downside to wearing a seatbelt or helmet. If there were a down side, then I would vote that we leave the decision to the individual.

So, what about smoking, the number one killer in the world? Why don’t we have a paternalistic stance and ban the stuff?

When it comes to medical recommendations, there is almost always a need for informed consent. There are pros and cons to the procedure. This is where paternalism is a very bad thing. This is what I was trained to watch out for, and I’m sure my peers were too. At the top of medical ethics committees are these types of questions: “is it ethical to mandate this treatment?” or “what would the patient decide using common sense and the current knowledge?”

Shared decision making, in which doctor and patient exchange knowledge concerning the patient’s disease and its treatments, discuss treatment options, and jointly choose one, or decide to do nothing, is the gold standard for how we as doctors should approach all decisions. Studies show that patients prefer shared decision making and informed consent when faced with medical decisions. You can read more about this here… and here…

Parents and citizens of the world, we are at risk of losing our medical freedom if we roll over and ignore the assault on these freedoms that is coming in the form of mandated medical care. The most obvious example of this paternalistic medical abuse is in the arena of vaccines. If the medical procedure of vaccines is mandated by the state, then we no longer have medical freedom, we no longer have the freedom to choose our medical care, and we have crossed over into a very dangerous practice of State mandated medical procedures!


Dr. Paul


Is Your Television Killing You?

tvAs a pediatrician, I’m constantly reminding parents to limit their children’s screen time. We try to keep children under two as screen-free as possible. The whole family is better off health wise, especially the children, when non-education video game playing, mindless Internet surfing, and passive solitary TV watching is limited.

Now a recent study, “Causes of Death Associated With Prolonged TV Viewing,” published in the American Journal of Preventative Medicine, suggests that TV watching is bad for grown-ups as well.

A team of researchers from the National Cancer Institute in Bethesda, Maryland, followed nearly a quarter of a million healthy 50 – 71 year olds for an average of 14 years. They found that those adults who watched between three and four hours of television per day were 15 percent more likely to die from any cause than those who watched less than one hour of television per day.

Even more disturbing, adults who watched seven or more hours of TV a day were 47 percent more likely to die than those who watched less than an hour a day. 

Diseases significantly linked to increase TV time include cancer, heart disease, chronic obstructive pulmonary disease, diabetes, influenza/pneumonia, Parkinson’s disease, liver disease, and suicide.

The take-away message: Watching television is bad for your health.

Is TV bad in and of itself? The researchers aren’t saying that. But we all know that watching television is a solitary, isolating occupation that keeps you sedentary. Sitting in front of the boob tube reduces the time you have available to exercise, interact with your family, read books, and be outdoors. This new research dovetails with other studies, which have linked excessive TV time to obesity and higher rates of cardiovascular disease.

I’ve been talking to parents about their kids but the most important message may be for parents and grandparents: watching too much television can jeopardize your whole family’s health.

This new study should be a wake-up call to all adults. Stay active. Go outside. Spend time with your spouse and your children with the television off. Read a book and do crossword puzzles to stimulate your imagination and your brain. Reduce your screen time as much as you can.

The National Cancer Institute researchers suggest that watching TV is a public health issue. The price we are paying for our technology-driven lives may be much higher than we previously realized.

Now please excuse me while I switch off the tube.


Dr. Paul




Dr. Paul Thomas, M.D. is a board-certified pediatrician and an addiction specialist. He has over 11,000 children in his integrative practice based in Portland, Oregon. Subscribe to his YouTube channel, and follow him on Facebook.


What Makes For a Lasting Marriage? Gratitude. Keep a Finger on the Pulse of Your Persons’ Emotions

weddingWe all want to have a happy marriage, one that lasts, that endures through the good and the bad, sickness and health, times of plenty and times of hardship. So what is the key to a long and happy marriage?

In the study, “Linking financial distress to marital quality: The intermediary roles of demand/withdraw and spousal gratitude expressions” a few key points become clear.

  • Demanding things, change, and/or withdrawing your love and affection is a negative conflict pattern that harms your marriage.
  • Feeling appreciated and believing that your spouse values you directly influences how you feel about your marriage for the better.
  • Financial distress is a big cause of marital problems
  • Gratitude, saying thank-you has a powerful protective effect that can overcome most negatives in a marriage.

You can read this study here…

I am one of the luckiest men on earth when it comes to marriage. My wife Maiya adores me, she appreciates me, she is always expressing gratitude for our relationship, for me, for things I may do, for what we have as a couple. I feel the same about her. She reminds me how those times when I check on her emotional well-being are so important. I haven’t always done well with complements, they make me nervous. Something for me to work on. Once, after she was showing gratitude when I was genuinely concerned and she felt the love, I responded, “I keep my finger on the pulse of your emotions“. We’ve used that sentiment often.

Be grateful, not just for things done for you, but just for being together. This gets to the heart of the unconditional love that is the glue. I love being with you. Thank-you for holding my hand. Thank-you for loving me. Thank-you for sharing this life journey with me.

Parents- this works for kids too. Show them love and gratitude just for being in your life… and watch them light up!


Dr. Paul


When Should I Introduce Gluten For My Baby? Delaying Gluten Exposure Until Age 2 Cuts Celiac Disease Risk in Half

Wheat2As a pediatrician, I’m counseling parents every day on when to start solids. We used to say to wait until 6 months as early introduction of food proteins increases allergies. We were 100% WRONG!  Introducing solids starting at 4 months significantly reduces allergies, even when it comes to peanuts as shown in this study here…

But when should we introduce gluten? I discussed this in a previous blog on this topic (found here… ) For those of you with a family history of celiac disease (a severe gluten-caused intestinal disorder), your risk of getting ill with celiac disease if you eat gluten (regardless of when you start) is about 5-12% by age 2-3 years, and 16-24% by 10 years age. If you never eat gluten, guess what your rate of celiac disease is? ZERO!

In the study, “Randomized feeding intervention in infants at high risk for celiac disease,” gluten triggered celiac disease in high risk children. You can read this study here…

The recent study, “Effects of Gluten Intake on Risk of Celiac Disease: a case-control study on a Swedish birth cohort,” showed that intake of gluten before age 2 years increased risk of developing celiac disease in high risk children (those with family histories or known genetic risk factors) 2-fold (more than doubles the risk). You can find and read that study here…

As percentages of children who have challenges with wheat increase, and numbers of those with frank celiac disease increase,e we need to re-think the use of wheat all together. Celiac disease is thought to affect 1 out of every 141 people in the USA (read here… ) and as high as 1 in 22 if you have a close relative with celiac (read more… ) We know that the numbers of people who are sensitive and not tolerating wheat are much higher. The condition is sometimes referred to as non-celiac gluten sensitivity (learn more here …)  and while there is raging debate in the literature about what that is and if it even exists, those of us who are looking for gluten issues when we have patients with GI or neurological, psychiatric, or skin disorders are finding that often the elimination of gluten is the key step in healing the condition.

This begs the question: Why are we forcing this protein on our children when it causes so much pain and misery to so many? I would have to answer: Money, Politics, and Tradition. We are all raised in the post-industrial revolution era. We are products of nations that transitioned from hunter-gathering people to those with agriculture. Grains allowed us to store food for the future, then, with our processing abilities, we are able to turn what was once a wholesome bread into delicious cake and cookies, pastries, and the like. Try walking past any festive occasion and avoid gluten! To make maters much worse, through hybridization and genetic engineering, we have changed wheat so much that I suspect our immune system sees it as a foreign invader. That certainly is the case for those with celiac disease, and it seems to be the case for those sensitive to wheat and gluten (wheat, barley, rye, spelt).

If your loved one cannot and should not drink alcohol, do we avoid having alcohol around them?  Of course we would. Why would we sabotage our loved one? The time may be upon us that we have gluten-free homes, and attend gluten-free parties and gatherings out of respect for those among us who suffer when they eat gluten. Radical? You bet!


Am I ready to make this commitment? Are you?


Dr. Paul


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