Education And Debate

Patients' prerogatives and perceptions of benefit

BMJ 1996; 312 doi: (Published 13 April 1996) Cite this as: BMJ 1996;312:958
  1. Frank Kee, honorary senior lecturera
  1. a Department of Epidemiology and Public Health, Queen's University of Belfast, Royal Victoria Hospital, Belfast BT12 6BJ
  • Accepted 18 December 1995

Patients today demand more information about their treatment. Doctors, however, seem reluctant to cast aside ingrained habits of paternalism, believing they can best interpret therapeutic choices for their patients. Whether doctors can be more objective and effective than patients in interpreting the “probabilities” of medical evidence is open to question. On the other hand, the exercise of choice by patients may itself have a bearing on the probabilities of outcome. Involving patients more in making therapeutic choices is justified if doctors can present options in an unbiased and effective manner and if the process improves the outcome of the care delivered.

A prominent medical educator reputedly once told a group of students: “Half of what we teach you is wrong; our problem is to determine which half.” However, exposing the scientific frailties of current medical practice is still a relatively novel pursuit in British medical schools. Whether in response to a rising current of consumerism or litigation, patients have begun to question their doctors' “certainties,” demanding more and better information about their care. Despite this, reports of the demise of paternalism are premature. While there are those who hold the view that medical “power” rests as much on uncertainty as on technical expertise, it would seem that physicians “must strike a balance between submerging their patients in information, thereby diminishing their patients' ability to make rational choices, and restricting that information to simplify decision making.”1

Such views presuppose the ability of doctors to make entirely rational choices based on new therapeutic information and reflect a rather limited view of the value of the information and dialogue that is shared with patients. Perhaps it is time to question some of the apparent underlying assumptions.

Do doctors give sound and unbiased information about therapeutic choices?

In an intriguing study Cassileth et al asked patients and members of the public what would …

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