The Myth of Doctor Knows Best

Doctors shouldn't have personal opinions. At least, that's the anecdotal evidence I collected in a recent online survey. All the patients I talked to said they would find another doctor if the one they saw a doctor who took their patients' health decisions personally. We believe, pretty unanimously, that our health decisions are ours and ours alone. That the doctor is there to provide council, advice, access to therapies, medication and aid devices as needed---without judgement. It's our belief that it's none of our doctors business why we refuse a suggested course of action. The doctor should never be offended if we don't agree with their suggested course of action. As patients, we should know all our options. And doctors should always be professional, never personal. "My body, my life," is the overwhelming consensus among patients.

But from the doctor's point of view, they're the ones who got the education. They're the ones who woke up for those 8am classes and studied instead of partying as an undergraduate. They're the ones who slaved for the MCAT. They're the ones who memorized all the bones, muscles, and half a million other things. They did the residencies working in crisis conditions. They're the ones who have seen people with conditions worse than yours. They KNOW. They've worked hard to get here. They have the degrees to prove it. Why aren't their patients more trusting? Why aren't their patients more grateful?

One difficulty with assuming "doctor knows best" is that our understanding of our bodies and how they work is evolving every day. There are studies out now that show that, "You can look great in a swimsuit and still be a heart attack waiting to happen. And you can also be overweight and otherwise healthy. A new study suggests that a surprising number of overweight people -- about half -- have normal blood pressure and cholesterol levels, while an equally startling number of trim people suffer from some of the ills associated with obesity." (Half of overweight adults may be heart-healthy.) We go so far as to have a world-wide campaign against obesity because "health care told us so." but sometimes our assumptions are downright wrong. We can't necessarily look at a person and know whether or not they're healthy. Not even if they're fat!

It's additionally difficult to trust a doctor's opinions for us when we know that doctors will choose more risky procedures for themselves, but won't suggest the same to their patients. Equally troubling is the recent study that showed: When you dislike patients, pain is taken less seriously. Before you say (as one article did) that the study used "observers" and not professionals like doctors, know that doctors are just as vulnerable to irrational decisions as laymen. A 1995 showed that doctors, specifically, are vulnerable to irrational decisions making: "In one scenario involving a patient with osteoarthritis, family physicians were less likely to prescribe a medication when deciding between two medications than when deciding about only one medication (53% vs 72%; P<.005). Apparently, the difficulty in deciding between the two medications led some physicians to recommend not starting either. Similar discrepancies were found in decisions made by neurologists and neurosurgeons concerning carotid artery surgery and by legislators concerning hospital closures." (Medical Decision Making in Situations That Offer Multiple Alternatives)

As a patient, I know: Caveat Emptor - Let the Buyer Beware.

Now, it's not my intention to vilify doctors. Far from it. What I'd like to offer is a way to improve your patient relationships.

First, it's not about how much you know or how much education you got. Your technical skills will be proven with the care you provide. Check your ego and emotions at the door (as much as possible).

Second, make your patients feel like the priority. "A nationwide study ...recently conducted from a sample of 10,000 individuals reveals that for physicians, the medical outcome and the extent to which the physician prioritizes the patient’s case gains the patient’s trust." (GW Assistant Professor of Organizational Sciences Nils Olsen researches how people deal with complex choices.)

Third, realize that you are just as susceptible to irrational behaviors as the rest of us. Getting M.D. tacked to the end of your name did not turn you into Mr. Spock.

Finally, "doctor knows best" is fantasy we should lay to rest... for all our sakes. It's never fun to have egg on our face. And if our doctor-patient relations is based on "doctor knows best," well, it looks much that worse when things don't turn out how we expect.