Over the past 40 years I have cared for and cared about thousands of patients. It has been a privilege.
I make a point of listening actively and interactively with my patients. I fervently believe that their medical decision-making should be as informed as possible. I want their decisions to be driven exclusively for their benefit. I have always run interference for my patients in order to serve this ethic, a commitment that calls for an ever more concerted effort as other "providers" and many "health" agencies have acquired conflicting interests.
I have no intention of slacking off, but my ripe old age is looming, and my ability to fight on their behalf in the future is uncertain.
There are impediments to making informed medical decisions that are increasingly subversive and insurmountable. Furthermore, my patients are more and more likely to be saddled with charges that underwrite incompetence. I never wanted to put words in the mouths of my patients. Perhaps I can be forgiven this lapse.
There are inalienable rights that every patient must demand in order to insure that their decision making, when it comes to medical issues, is informed:
No physician or surgeon should brandish "clinical judgment" or "common practice" as the reason for doing anything to a patient without stating that there is no science to inform the decision. The patient needs to understand the track record that supports the clinical judgment, the track records of others who suggest alternatives and the likely outcome if "watchful waiting" is the option chosen. Furthermore, the choice of "watchful waiting" or another physician's best guess should never incur derision or otherwise feel pressured.
No physician or surgeon should prescribe a pharmaceutical without detailing the basis for certitude that the agent will benefit the patient. What is the likelihood that the patient will be better off, in what time frame, and to what degree? If the science is not sufficiently compelling, the patient is free to demur without incurring derision or feeling pressured. If the patient finds the science sufficiently compelling, information as to any potential downside must be provided so the patient can weigh the benefit/risk ratio.
No physician or surgeon should substitute a newer pharmaceutical for a drug already prescribed without detailing the evidence that the new agent offers greater likelihood of meaningful benefit. Dosing convenience and theoretical effectiveness are not determinative. If no important health advantage has been demonstrated, uncertainties as to long-term adverse events are intolerable and the patient can demur without incurring derision or feeling pressured.
No surgeon should put any device into any body without explaining the scientific basis for asserting that the patient will be receive a meaningful advantage in the short term and in the longer term. If the basis for the procedure is solely theory and preconception, the patient is free to demur without incurring derision or feeling pressured.
No diagnostic study should be performed unless the test is interpretable in a fashion that benefits the patient. The test must detect a specific abnormality, one that is highly likely to play a role in the current illness. Furthermore, the detection of such must lead to a clinically meaningful insight regarding prognosis, if not to therapy.