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Archive for January 1st, 2013

What’s past is prologue

Today marks the five year anniversary of the blog. I was not part of the initial stable of writers, my first entry published Jan 31. As I remember it shortly thereafter they browbeat me into writing twice a month. I had a lot of hesitancy participating as I was uncertain I could keep up with the twice monthly writing requirements. I am a slow writer and a slower typer, but it has been one of the most intellectually rewarding experiences of my life.

I have become a better writer, but more importantly a vastly better thinker, as a result of interactions with SBM. I have also been convinced I have some sort of language processing disorder as I still can’t see how those pesky typo’s disappear during my countless rewriting only to reappear in the final draft. Either WordPress inserts them automatically or it is magic most foul.

Five years on, and a new year, are as good an arbitrary time as any to reflect on both the past and future of SBM. As I age the more I am of the opinion that I have the carte blanche of the elderly to say whatever I want. It’s all about wearing the purple. (more…)

Posted in: Announcements, Science and Medicine

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Beyond Informed Consent: Shared Decision-Making

Happy New Year to all our readers! Today marks the completion of 5 years of SBM and the beginning of year 6. My contributions, at one a week, have now reached a total of 260. My first post on this blog, 5 years ago, was a review of an important book about science and alternative medicine, Snake Oil ScienceThis year I’d like to start with an important book about communicating medical science to patients, Critical Decisions,  by Peter A. Ubel, M.D.

I was wrong about informed consent. I thought informed consent was a matter of explaining the risks and benefits of treatments to patients so they could decide what they wanted to do.  That was naïve, simplistic, and misguided. Ubel’s book has radically changed my thinking about how doctors should interact with patients.

Paternalism in medicine is dead. Patient autonomy rules. We respect the right of patients to determine their own treatments, even if their choices seem unwise to us. Patients should do what they want. But there’s a problem: patients may not know what they really want. Emotions and unconscious and irrational forces influence their medical decisions. Preferences can change from one moment to the next, and they can shift with subtle changes in how treatments are described and how the issues are framed. Doctors need to develop a better understanding of what is going on in their patients’ minds, of how the way they present treatment options can inadvertently influence patients, and of how they can participate with patients in a process of shared decision-making. It’s possible to provide direction without paternalism. (more…)

Posted in: Book & movie reviews, Medical Ethics

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