Healthcare Transparency or Too Much Information?
When you read an ad for any drug in a magazine you will notice that many drug ads are at least two pages. The first page, typically in bright colors and bold print, proclaims what the drug treats and why the medication is necessary. The next page (or pages) describing in detail (and small print) the side effects and negative reactions to taking the medication. If anyone bothers to read the disclaimer page, it would definitely give the patient a reason why the medication should not be taken. In some cases the incidence of side effects add up to over 100% of patients who take the medication will end up with side effects. (The math may be accurate because some patients will exhibit more than one adverse reaction to the medication.) This does not mean that the medication is not effective in most cases; it does mean that the prescribing doctor should know their patient and the medication they are prescribing.
There is a risk that doctors face by not providing their patients with all the pertinent information that the patient may want. That risk is all of the information that is available on the internet. Many patients will perform a quick web search and find all the information available on any medication or procedure that they are about to undertake. If the patient finds any information (accurate or not) that was not disclosed to them by their doctor, then there may be a problem for the treating doctor. At the very least the treating doctor must take the time to answer any questions which the patient may have. The patient may have lost some trust in the doctor, if they feel that their doctor withheld any information that the patient feels important. At worse the patient may threaten a lawsuit if they feel strongly enough that the withheld information would have caused them to change their mind about the treatment.
On the other hand if you provide your patients with every shred of information that you have and any treatment that you are recommending to your patient, then you risk ‘paralysis by analysis’ on the part of the patient. Many factors come into play when your patients make their decision on a treatment program, not the least is their understanding of math. In the March-April issue of the Hastings Center Report, bioethical investigator, Peter Schwartz, argues that too much quantitative information can make it more difficult for patients to reach a decision. He argues that many adults do not have the mathematical skills to process the statistics and numbers that quantitative information requires. Patients will also place more emphasis on the ‘latest’ information or on information that they can more readily understand, even though it may be less significant in their case.
Doctors also need to be aware of the many patient advocates using the term "quantitative imperative"--or the responsibility to reveal risk-related data to patients to help them make informed decisions. Even if the patient is comfortable with the decision they make about their treatment based on the information that their doctor provided them, there are always some patient advocates around looking to further their cause if they perceive a chance to do so.
My advice is to always know your patients, so that you can provide all the information which that patient requires to make an informed decision. Provide all the information that you, yourself would like to have to make a proper decision, and answer any questions that your patient may have. It is at times like these that you need to be a doctor not just a physician.
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