Friday, 16 October 2009

• Patients and Decision Making in Healthcare Contexts

  

  Most of us have been brought up to have a huge amount of faith in western system of modern medicine, but there are limitations in its assumptions which can lead to real problems which patients have to face all the time in dealing with their doctors and trying to identify and manage health conditions.
  
  The process of diagnosis is based on knowledge of a disease that is accumulated over time from studies that have been conducted on populations with the condition. If a condition is well-identified and doctors have been studying it for a long time, then hopefully they will understand it very well, and they will be able to easily and accurately identify the disease when they see it. If research in the area is advanced enough, then hopefully they will have a detailed understanding of what causes the condition and can offer a range of possible solutions. 
  
  But if not a lot is understood about the condition, then a doctor's efforts may have limited effectiveness. They might have trouble diagnosing the patient's condition correctly. Or they may not be able to find a solution that manages the condition effectively.
  
  Furthermore, idiosyncratic variation in people's bodies and the processes affecting them can confound doctor's attempts to diagnose and treat (or from the other point of view, patients' attempts to get help for their pain or ailments). If a patient's symptoms happen to be extremely different from what most other people have, then the doctor may not recognize the condition, or even if they do diagnose it, the standard treatments may not help.
  
  I have seen many different doctors about my back pain and have been very frustrated by the outcomes of these visits. Doctors could explain general theories about why the back degenerates, and they could tell me what the stage of my degeneration was, but they could not explain what was causing my spine to wear down, and they could not give me much help in managing either the pain or in controlling the source of the problem.
  
  Finally, the flow of information about treatments as well their comparative efficacy and risks is problematic. I think it is reasonable for the patient to ask for information which helps them understand how a treatment works, how established it is and how effective it might be, not to mention the risks they may be exposed to as a result of the treatment. This may be a reasonable expectation and one that health care providers acknowledge in theory, but in practice the constraints of time and money can prevent patients from being able to get the information they need to make a decision.
  
  A wealth of information is out there, much of it online these days, but the idea that the web makes information free for all consumers is an illusion when it comes to health care research. Most research is published in journals which require a subscription, and the average person who is not a student at an institution with access to these journals cannot browse the full article texts online to find what they need. The PubMed database makes some articles available to the public, but even with full access to the research it is difficult for the average consumer to make sense of the numbers and critically evaluate what is reported and how convincing the evidence is. There is a cost to getting the information, both monetary and in terms of the time and effort one has to spend in order to research all the recently published material.
  
  Is part of the problem is that we, as consumers of health care, are making ourselves helpless by relying too much on doctors to cure us? Wouldn't it be better if there were more alternative pathways to get guidance and information to deal with our conditions, for example such as physiotherapists or networks of patients who suffer from the same condition?
  

  • 9:45 PM
  • 229 Views
  • 4 eProps
  • 1 Comment