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Wednesday, April 7, 2010

The paternalism is a little more kind-hearted now: Patient's participation in medical decision-making

David Leonhardt tells this story in his column today:
Dr. Dale Collins Vidal, a reconstructive breast surgeon at the Dartmouth-Hitchcock Medical Center, told me a story about a patient's husband who asked to sit in on the medical team's discussion of his wife's case. The doctors said no, because they were uncomfortable with him knowing about the uncertainty surrounding the case. "The paternalism is a little more kind-hearted than it was in the past," Dr. Collins Vidal says, "but it's still paternalism."

As a rule of thumb, Don Berwick suggests "nothing about me without me." This fails the test.

Advice: Patients and their spouses need to learn about the uncertainty that usually accompanies the decision the doctor is making. If this is impossible during a hectic, scary time in the hospital, get a professional patient advocate to help you understand your choices. The alternative is to leave key decisions to well-meaning strangers who don't know your loved one's values and preferences.

Thanks to David Leonhardt for the source story in today's New York Times.

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