SC in constructing patient-doctor relationship

This post deals with the patient-doctor relationship and centers around the consultative session during which the patient and doctor 1) provide each other information regarding the patient's health and 2) the doctor makes recommendations regarding the care he is willing to provide the patient. The patient may consent to the plan of care the doctor is offering or may not. The patient may seek a second opinion or do nothing at all (assuming his condition is not contagious or obviously life-threatening). Using the social contract model, the patient retains responsibility for his own health care program, including its specific goals; and the doctor is advising what he can do with respect to that program. The patient and the doctor may agree to a further contractual relationship; and it is always to advantage to have any plan for further diagnosis and treatment in writing, preferably signed by the parties involved.

So what is this contract? The doctor promises to provide some particular medical services, e.g., administer tests and inform the patient of their results, and the patient agrees to pay for them. In the consultative session, information is exchanged but neither patient nor doctor need agree to either further testing or remedial treatment. Being a patient in no way implies coming under a doctor's control in the sense that the patient, as a contractual party, has given up his responsibility for his own health program.

In the book Hippocrates' Shadow, 2008, the author David H. Newman makes the point that the typical medical doctor is applying science, in particular, the results of scientific research, in the advice he offers to his patient. Newman argues that any advice should be sensible. It should be based on what procedures and methods are available given the patient with whom he is dealing. It could suggest, based on scientific evidence, that with the patient's age, gender and life-style, the patient is subject to a degree of risk of incurring certain diseases, but the patient must be convinced that what he is advised to do will be of benefit to him, not simply the advice a doctor would give anyone into whose class or category the patient fits.

Seemingly, the whole system of medical consultation is predicated upon an assembly-line approach to medical care, in which a doctor who detects the possibility of a certain medical malady in his patient, automatically ships him off to the specialist who automatically prepares him for the surgeon. For example, a patient who has fallen and incurred injury to his arm consults a doctor when the injury does not heal within a reasonable length of time. The doctor takes x-rays that reveal the arm is broken. In the consultative session, the doctor advises surgery, as if seemingly unaware that the arm could become just as usable by other methods, e.g., arm exercises and heat therapy. There's the way of surgery, and apparently, none other, for some physicians!

Offering sensible consultative advice means recognizing there's more than one way to handle a medical condition and that some measures for handling it are more appropriate in given situations. For instance, a kidney transplant probably is not a realistic option for an 85-year old man; and the surgeon who would recommend it may be uneasy in so doing. Again, the more options that are discussed with the patient--for diagnosis and for therapeutic treatment--the more confidcnt the patient can feel that the doctor is offering sound advice.

Nonetheless, the doctor who has rendered a medical opinion in a consultative session may be disposed to record not only his diagnostic findings but his recommendations in some database containing the patient's medical history. I think that to do so would negate the conditions of the contractual agreement between doctor and patient as agreed upon. But the doctor may feel himself in position to truly assess the patient's health status as to be certain of his advice. As stated in Hippocrates' Shadow (though not in these words), the doctor may believe with scientific certainty (because he is relying on scientific research) that he knows the patient's health better than the patient himself, and may contend, upon such knowledge, his remedial plan has been formulated. That is to say, for some physician who has performed tests and rendered his opinion, the matter of what the patient must do is a certainty!

Oh, those consultative sessions! A matter of conflict of interest?
For the doctor who both has administered diagnostic tests and rendered a course of remedy, there might be construed a conflict of interest. For he stands to benefit from continuing with the patient in most cases. When the tests are conducted in the doctor's own offices and by his own staff, there might be further cause for suspicion rather than for trust. This may be especially a patient's concern when the patient has consulted with the doctor for just some initial sessions.

Incidentally with regard to my own experience through the years, I've found that independent medical groups--such as laboratories, ambulance personnel, and screening agencies; and even county health fairs--are useful in informing about my personal health. It would probably be more beneficial if medical practitioners doing diagnoses of one's health be not involved in the remedial determinations.

We all are familiar with the book Arrowsmith by Sinclair Lewis. It raises our awareness that certain treatments are more advantageous for the doctor to recommend. We're also familiar with the practices of some automobile mechanics who, merely by noting a car 5 years old, say, will recommend a rebuilt transmission replace the one giving the owner problems, whether or not there's sufficient reason for a replacement. That doctors may make recommendations based upon categories into which a patient may appropriately be place, e.g., he's over 65, suggests the ready-made approach to the consultative session, i.e., the patient is merely a category-type.

Further consider in the automobile example, that should a rebuilt transmission be installed, the customer may incur further automotive malfunctions, simply because the other parts with which the rebuilt transmission functions are old. Particularly where the medical procedures are invasive, the patient may experience adversive effects because of them.

So, don't forget the option for a second opinion!
The notion of getting a second opinion stems from the recognitioon that the patient has not agreed to any further testing nor medical proedure with the doctor beyond that of the consultative session. To be of even greater value, the doctor whose opinion is sought as the second opinion should conduct his own series of tests before rendering his advice; and preferably, to assure objectivity, he should not be part of the same medical unit as the doctor who offered the first opinion nor of the same hospital staff.

Non-traditional therapies
A common complaint of patients is that the doctor whose opinion they sought does not know of homeopathic remedies nor of alternative approaches to health care than that offered through medical science. Yet, there are non-traditional therapies; and there are consultants familiar with their applications. After all, some of these remedies have been developed and used over centuries.

Vitamin supplements may be useful, too. The aim is to develop a strategy that makes sense to the patient, particularly with respect to cost and the likelihood of being effective.