270 Interacting with Their Patients
In the past, the authoritarian physician could do what he or she thought was best for the patient. Maybe it was best for some given percent of patients a high percent of the time. Patients probably weren’ t totally happy, unless they liked authoritarian physicians. Other patients wanted more‘‘ say,’’ and understanding: not be as much‘‘ say’’ as‘‘ understanding.’’
Though some patients wanted decisions made for them, or sought only explanations, at the far other extreme some doctors now saw patients as full equals with whom to make joint decisions. With his patients, Juan, for example, sought as much balance as possible.
My role is as an advocate, a teacher, so that they can understand the‘‘ medicalese’’— the concept behind the drugs— and make their best decisions. I now tell patients,‘‘ I’ m not going to tell you what to do. I’ m just going to give you the information so you can make the best decision.’’ Patients said that that approach was different from what they got elsewhere, and that was why they were coming to see me.
Patients thus selected or rejected Juan based on his stance toward them.
Other patients preferred more direction and‘‘ answers.’’ Ronald, the suburban radiologist, reported that after he gave patients information for them to make decisions, a third would ask him,‘‘ What would you do if you were me, doc?’’
Sometimes I’ m just talking over their heads, even though I’ m trying not to use big words. One of the hardest things we try to explain is why, with unresectable lung cancer, I wouldn’ t cut it out anyway. Patients say,‘‘ Why don’ t I just undergo surgery?’’ It’ s difficult for them to understand: It’ s not going to influence their survival.
The many inherent ambiguities in medicine were difficult to convey because of high degrees of uncertainty, invasiveness of treatments, patients’ potential understandings, and personal communication preferences.
Physicians’ nondirective approaches could even offend and confuse patients. Sally, who brought her laptop to the ICU, explained,‘‘ When I laid out some options, one family said,‘ Doc, don’ t you know what to do? You want us to decide?’ I tried to explain my rationale to them. It was far from what they expected from a doctor!’’