Making Wise Medical Decisions. When I saw it on the shelf of the public library, I was understandably intrigued. It's a paperback book about three-quarters of an inch thick, and I figured it must represent a pretty powerful distillation of wisdom if it manages to encompass such a topic in such small space.1 Then I saw the subtitle — “How to Get the Information You Need” — and I realized that I probably had in my hand another patient vs. doctor book.
Sure enough, the book takes a stance guaranteed to make many physicians uncomfortable. It's written not for patients but for consumers of health care: “Just as they question the quality of commodities that they purchase, many individuals in need of health care question their doctors' advice through second (and third) opinions and through reading about the recommended procedures themselves” (page 9). The book speaks of ending the physician's “monopoly over information”: “Once patients become empowered with information, physicians lose their monopoly and often feel threatened” (page 10).
Whether you do in fact feel threatened by the loss of your information monopoly or delighted to see so many patients taking an active part in their health care no doubt depends on your personality, training and experience. But whatever your reaction, I hope you take this sort of consumerism as a challenge to be met. It seems clearly to spring from a perceived failure of the physician-patient relationship or, to put it more bluntly, a perceived failure on the part of physicians. For instance, do you believe that “reviewing the medical literature on mammography is the only way for a woman to decide if a mammogram makes sense for her” (page 166)? Surely not! But if not, how sure are you that you can do better for her than MEDLINE?
It's easy for a book like this to send the patient to journals, medical texts, the World Wide Web and self-help organizations, but it's not so easy for the patient to understand what the blizzard of information all means. The medical literature is an inhospitable landscape for those not trained in its ways. The good news is that you can't really be replaced by untutored research by a motivated patient. The bad news is that the patient isn't likely to understand that fact and may get into deep trouble unless you demonstrate your understanding and your willingness to help slog through the drifts of information. If this is the age of the empowered patient, who is better suited to empower that patient than a well-trained family physician?
Actually, I couldn't find any references in this book to family physicians as credible information sources, nor any reference to the AAFP's patient information resources. And that may in part explain the book. Maybe it's just that the authors, failing to appreciate the value of family physicians, underestimated the patient's best resource in making wise medical decisions. I'd like to hope so, anyway.