For thousands of years, patients have visited doctors for issues such as headaches, heartaches, and all kinds of “aches.” The symptoms and signs are reviewed, diagnosed, and a treatment is then recommended. In the past, the patient-doctor relationship involved the physician playing more of a father-type figure, with very few patients questioning the physician’s rationale or expertise. But now, the relationship has changed more to a principle-agent relationship, with patients coming with their own ideas for diagnosis, prognosis, treatment, and exercising their right to autonomy.
For example, a patient may be suffering from a rare condition and not able to get the best care because the diagnosis does not have a clear treatment due to insufficient information, or a drug was not developed due to high cost of research. We start to get involved, reviewing specific cases via the media or discuss it with our friends and family via Facebook. Rather than a one-to-one relationship with our provider, many others are now included.
Who else outside of our social realm is involved in the patient-doctor relationship?
We discussed multiple media platforms such as television, news, and internet sites or forums, and word-of-mouth discussions via family and friends. However, insurance, research articles or journals, law/regulations, and the government play an important role. We are inundated with “expert” information from all directions.
How much influence do these decision makers have within the patient-doctor relationships? In the case of MU regulations, certain practices and policies are required to be completed by providers in different groups. All of these are expected to make this information more concise, succinct, and make the workflow productive. However, in other government regulations, there are a few situations that show an extreme turn in which causes us to question who is the true benefactor of the decision:
A recent article in Slate discussed how the state of Arizona passed a bill on the basis of “reversible abortion.” What is surprising about this article is the expectation placed on medical providers to support the bill, regardless of the science behind it. The bill places expectations on the medical staff to convey to patients that reversible abortion is indeed a safe practice. Is this truly a safe option for women to choose if doctors are being required to state its legitimacy? Is there any medical reasoning or science proving its efficacy? This conversation opens a big can of worms with many opinions on all sides.
Medical journals also are considered a resource for trusted expertise. However, we are starting to see evidence of journals being flooded with scholarly articles that are not considered proper research. Biomed Central has come under fire recently for publishing fake articles and Elsevier has published periodicals that resemble peer-reviewed journals. Research scientists and published academic professionals may be able to see when certain information is inaccurate or poorly designed, but the common public or media may not be able to make this distinction.
In my previous blog, it was discussed that certain effects and adverse reactions to pills and the pharmaceutical industry may not have always been disclosed to providers or the public out of self-interest, and for some medications the ramifications were disastrous. It resulted in a domino effect of legislation being passed and a general distrust between the public, governmental sector, and the pharmaceutical companies.
Information technology plays a pivotal role in the decision making. Most of us have gone to the doctor and noticed that our information is now being typed into an EHR, which helps track our current and historical care data. This information helps us keep track of when our next colonoscopy needs to be completed to when our vaccines were taken. However, this can also be taken to an another level when our information is used to limit our choices to determine how we can get sick before we actually do, or gather information from other sources without our knowledge.
Information technology can help tie our health habits to our credit cards and provide that information to insurance and providers. This has already being seen at one hospital system in the Carolinas, where they purchase the different data and run algorithms to find those patients who may need an intervention. This type of behavior is expected to be help consumers act in their best interest when it comes to their health, but others see this as another level of intrusion.
These situations are not always black and white, but they must be discussed to determine and establish what is and what is not an appropriate approach and whether the findings fit into the health literature system to further scientific discovery. For many, going to the doctor is already a stressful situation. If the scientific knowledge base is contaminated, the decisions being made may cause unintended consequences.
How do we as common consumers determine which source to follow if there is conflicting information? How do we know our decisions are made using the best possible research and information? Oh, what a tangled health care web we weave when we practice to relieve.
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