Why Wouldn’t My Doctor Tell Me What Treatment to Get?

The July 14, 2019 New York Times Sunday Magazine had a "The Ethicist" article concerning a letter from a reader puzzled by their urologist's refusal to offer a recommendation on the best way to treat their prostate cancer. The patient was, instead, urged to do their own online research and develop their own plan.

Interestingly, The Ethicist's answer leads with a long discussion of how physicians hate patients who think a Google search makes them an expert on a diagnosis.  I think The Ethicist answered the letter with a confusing and mis-conceived letter of his own.

Here is what I would have written, instead:

Your doctor appears to have taken the current encouragement of shared decision making in the health care context all the way to abdication of the physician role.  You need a different urologist.

The urologist's job was to learn enough about you to understand what questions you might have about the array of treatment (and non-treatment) choices before you for your diagnosis. The urologist's contribution should have included information on which are the most common treatment  and n0n-treatment plans, patterns of post-treatment feedback from patients, and a discussion of the risks attendant on each approach.

As you are by now no doubt aware, treatment (and non-treatment) for prostate cancer can affect sexual function. The risk of such an outcome may be difficult for some individuals to discuss kindly and rationally, which is why anyone who cannot perform this essential step should not be a urologist. Indeed, if "just Google it" was the urologist's best advice, you are entitled to a refund of any fees charged for this visit.

 

 

 

 

One comment

  1. Pretty sad to read this. But beyond complicated ethical and legal issues arising here:
    It seems that the patient is a philosopher. One may assume, that he has more cognitive and intellectual capacity, to conduct such research. But what if one person has low level of capacity for conducting such complicated research ( in terms of technological dimension, and intellectual as well ). The physician must diagnose it, and act in accordance. For otherwise, such patient, may reach very wrong conclusions, or not at all, or : become mentally very upset and disoriented. What then ? It would be considered as malpractice. Tort. Negligence. Some guidance must be performed here. Because, once illiterate or alike person, must get advises and guidance one must assume ,then, in accordance, one may argue, that must be implied as general standard, with no personal or personality differentiation.
    P.S.: he could at least provide him, with some key words for search, right?
    Thanks

    Like

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