Comprehension Comes Before Consent
February 15th, 2013 at 11:27 am (Education, Health, Medical Ethics, Patient Information, Responsible Chiropractic)
I have heard this way too often and it is always alarming. Patients come in with a diagnosis they do not understand and are following a treatment plan that either doesn’t make sense to them, or that they do not want to follow.
No Dr. Bear. I need treatment, not balloons.
This drives me nuts! Is this lapse in appropriate information on the doctor’s side or on the patient’s side? Where are these doctors failing to explain a patient’s diagnosis? Why are there patients content with understanding as little about their health as is possible?! So the following rant is designed to be a public service announcement.
1st, to the Patients: please, please, please, please, ASK questions. While some doctors may excel at mind reading, most of us do not. We spent so much time in school learning complicated terminology that at times we may forget to clarify in an easy to understand manner. The word “doctor” is actually derived from the Latin word for “to teach”. After your doctor diagnoses your condition, the next step should be a conversation regarding what it is and what it means. No one will look down on you because you are not well versed in human anatomy, physiology, and pathology. The human body is absurdly complicated, and comprehension of how it works often takes years of schooling and practical experience (AKA Med School/Chiropractic School, etc). So while just about everyone knows what “Kidney Stones” are, a lot of people would be confused if their doctor told them they have a Nephrolithiasis. When in doubt- ASK. Having questions is expected, and most doctors will not be upset about a patient wanting to know more.
Next, as with any human relationship- if you don’t like your doctor or disagree with a recommendation you CAN get a 2nd opinion or even change doctors! I hear several times a week “I’ve been going to see Dr._______ for 5 years, but I can’t stand the guy!” Why on Earth would you spend your time and money seeing someone you don’t like and don’t trust! Here in Rochester, there are numerous specialists in a wide variety of fields (I would assume it is same in any moderate or large sized city). If you are willing to travel, you can often find a doctor who is a good fit for you and what you need.
Although… in some locations you may consider taking any medical advice you can get….
2nd to the doctors: Remember, you are treating people. Many of these people are smart and willing to learn, but have zero training on how the human body works. As a Chiropractor I see back pain ALL day every day, and while the vast majority is a simple fix I always try to remember that it is often scary and confusing for the patient who is in pain. I have to give kudos to the emergency room staff, oncologists, and other health professionals in fields that deal with more terminal conditions because giving bad news is the worst part of the job… But it is part of the job. INFORMED consent is a vital part of the healthcare, and if the patient doesn’t understand their health it is impossible for them to properly consent.
In my book, comprehension from the patient is just about as important as a proper diagnosis and the proper treatment. While we see the doctor to get evaluations of our health, the bottom line is that it is still YOUR health. If you don’t understand something, ask. Then ask again, because sometimes we forget.
End rant.
Questions? Comments? Feel free to contact me- Dr. D.

Dr. Duncan said,
February 18, 2013 at 4:37 pm
I see this a lot too. I especially hate it when patients don’t know what to expect. Either no goals were set with the patient, or the patient didn’t agree and so didn’t bother to remember. Every treatment plan should have a goal outcome, and both the doctor and the patient should know if they are reaching their goals in a reasonable time. If they aren’t then the treatment isn’t working as expected and should be re-evaluated. When I ask if the treatment they have been getting is working I should get a better response than “I don’t know.”
tdaly said,
February 24, 2013 at 7:13 pm
Excellent point Dr. Duncan! I think more emphasis needs to be placed on the fact that the patient and the doctor are a team, working towards the patients health. I feel as though many people are hard wired to go along with whatever their doctor recommends regardless of whether or not they agree. Always glad to see other doctors interested in and working to change that paradigm- keep up the good work Dr. Duncan!