Should doctors trust patients?

Yes, you read that right. Doctors often wonder if they can trust their patients.

Most patients want a trusting relationship with their doctor and they assume that the only issue is whether the doctor is trustworthy. However, a lot of the problems in the contemporary doctor-patient relationship stem from the fact that doctors cannot be sure they should believe their patients. Patients insist that they are educated, that they want to manage their care and that they want treatment plan A. Yet when treatment plan A does not work out, they are unhappy with the doctor. He or she should have explained it better or been more aggressive or refused to go along with their plan.

Don't believe me? Here's an excerpt article by a professional journalist detailing her years of infertility treatment, Not giving up hope for a biological baby:

My first doctor in Santa Monica, Calif., was thoughtful and attentive, with an Ed Harris sort of look and a kindly, if somewhat passive, approach. The fertility practice he was part of had wonderful nurses, a sleek, minimalist aesthetic and a reputation for a celebrity clientele.

My second doctor was in Arizona, a blowhard with pictures of his success stories (i.e., babies) insensitively plastered on the walls of his tacky Southwest-décor office. (Please don’t make infertile women look at photos of other people's kids, I wanted to scream.) After keeping me waiting for 45 minutes, his first words on hearing my history with the L.A. doc were that I should have done a single round of IVF instead of the seven inseminations — I would have been more likely to get pregnant, he said. Very helpful, I thought, since I can’t actually turn back time. I disliked him immediately.

But who do I think was the better doctor for me? Probably Dr. Arizona. The truth is, in retrospect, I should have had a doctor who was much more aggressive. Though I had no history of any sort of physical problem, I believe I should have started drugs much sooner, and my L.A. doctor should have tried to make a case for IVF rather than simply swallow my (admittedly defiant) declarative that I would not do anything high-tech...

I said I'd never do IVF. Never. That was when I was 37, when it wasn't so much that I had hope as that I had no doubt that this would work. It wasn't even a question in my mind...

So the patient ignored the advice of her doctor and told him that she would not follow his recommendation ever, under any circumstances. Instead she asked for, and received, the treatment that she wanted.

She was wrong. Now she knows that, but her doctor knew that at the time. In retrospect, does she blame herself? No, her doctor should have been "much more aggressive" and he should have argued with her rather than "swallow" her clear, unambiguous refusal to accept his treatment plan. At no point does it occur to Ms. Parch that this is her fault and that she bears sole responsibility for what happened.

These situations happen quite often. Patients make demands or refuse treatments because they believe that they are "educated" about their options and they are in the best position to decide what is most likely to work. Now just imagine the same situation playing out with a baby's life at stake. The doctor recommends a C-section or an induction and the patient refuses. Should the doctor just accept that refusal? What happens when the baby is harmed or dies? Typically what happens is that the patient blames the doctor in exactly the same way that this journalist blames her doctor. She refuses to accept responsibility for the results of the decision that she made.

Patients complain that doctors do not respect their decisions, but how can you respect a decision if the patient refuses to take responsibility for it?


This piece first appeared in September 2009.