When you or I visit an accountant, a lawyer or car mechanic, we know what our role is and have a pretty clear understanding of what the ' expert' is supposed to do. But when it comes to a trip to the doctor these days the roles and responsibilities of patients and physicians have become blurred and unpredictable'and the patient seems to generally be on the losing end
Take my Mom's case. My Mom who was 89 years old and evidently had severe osteoarthritis. She never knew that even though she was been seen every couple of months by her Internist for years and years. It's too bad'because my Mom died last week from complications due to a compressed fracture of her spine. Turns out her spine was very fragile according to her consulting Neurosurgeon but no one ever told her.
The first question that entered my mind when I heard of her condition was why didn't her primary care physician 'pick up' on the severity of her condition before she fell and fractured her spine?
From my perspective, my Mom's primary care physician should have told/warned her as to the severity of her condition. As it was, she was never prescribed any medications or dietary supplements nor was she advised of the benefits of staying active.
My wife says my Mom should have been aware of the fact that older women routinely experience bone loss. After all, there are ads everywhere warning of the perils of osteoporosis and the benefits of staying active.
So how are patients supposed to know what they are supposed to know?
Is it common practice for physicians to assume their patients have a certain level of health knowledge? If so, is there a difference between expecting patients to understand the perils of smoking versus the perils of bone loss? I was not aware that compression fractures of the spine were so common among women with osteoarthritis. I bet most non-physicians aren't aware of this fact either.
Where is the dividing line between what patients are supposed to know versus what physicians have an obligation to tell them?
I am all for have people take more responsibility for their health. I understand that physicians can not possibly handle the competing demands they face and that patients have to do more. The problem is that it seems that someone should tell the patient!! If physicians expect patients to take on more responsiblity for their health then why not explain that to patients? But simply telling patients they have to do more is not enough'patients need to be taught what they need to know and what they need to do.
This problem seems to be particularly acute for the elderly. Having grown up before the age of patient empowerment, they generally do what they are told by their physician. If something is important, they believe that their physician will tell them. Unfortunately the rules have changed and I fear that patients are the last to figure it out'often when it's too late.
Going forward I hope doctors and patients start having frank, honest discussions about expectations and responsibilities. Yes it may take a minute or two'but in the long run it should save lots of time, pain'and yes even prevent accidental falls and untimely deaths.
That's what I think. Please share your thoughts and experiences'don't be afraid to disagree.
More information on this topic with The Center for Advancing Health's "Creating a Patient Guide for a Clinic or Medical Practice" and "Supporting Patients' Engagement in Their Health and Health Care."