Shared Decision Making Between Patients and Doctors Improves Outcomes
Henry 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:
- The value we place on the freedom of persons to make their own choices about how they will lead their lives.
- 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!