Doctors and their patients do not always see eye-to-eye. Indeed, patients do not always understand the risks and benefits of a given procedure. Slate asks, Medicine, surgery, side effects: Is your doctor telling you enough about the risks? Doctors sometimes get caught up in their own knowledge and often do not realize what patients do not know. Doctors may be short on time to discuss treatment side effects. They may believe they know best and do not want to muddy the water with unnecessary discussions. Indeed, one attorney I spoke with told me about the time his wife was discussing a surgery for his son to correct a sports injury. The surgeon became exasperated and said he would withdraw from the surgery if she did not stop asking questions. The following is what Slate had to say:
To practice medicine ethically (and to avoid malpractice lawsuits), physicians must ensure that a patient has informed consent— that is, they must tell the patient enough information about the treatment or procedure for the patient to make an informed decision about their care…. But how much information is too much? How little is too little? Informed consent laws don’t get into specifics, leaving the question up to individual doctors.
Legally speaking, the answer here is relatively straightforward. “It’s what the reasonable person would want to know,” said Arthur Caplan, a bioethicist at New York University Grossman School of Medicine. Would a reasonable person want to know, for example, that there is a risk of death associated with anesthesia, albeit a small one? The answer may change depending on the context. For example, in an emergency situation, the stakes are often clearer: Rejecting a treatment could lead to the loss of a limb, or even the loss of life.
Not all medicine is initiated at the emergency room and there is a lot of room for different opinions, or second opinions. For example, YouTube’s “Doctor Mike” (Mikhail Varshavski) advises viewers to never rush to have musculoskeletal surgery, before exhausting less invasive, conservative treatments that often work just as well. Yet, physicians with specialized training in musculoskeletal surgery recommend surgery all the time to patients who may have other options. If they practiced medicine like Dr. Mike advises they could land in the proverbial poor house.
Patients do not always understand the risks and rewards of proposed treatments. More from Slate:
Research has shown, for example, that people tend to overestimate the benefits, and underestimate the risks, of medical interventions. In my reporting for a recent story on in vitro fertilization, patients told me again and again that they had assumed that IVF was a “guarantee.” It would be a hard road, sure, but at the end of it, they’d have a baby. One woman I spoke to said she didn’t realize how common miscarriages were until she had one herself at seven weeks. “No one prepares you for if it’s not going to work—so when it doesn’t, it’s just shocking,” she said.
Other problems are that patients do not know enough to know what they want to know. They experience cognitive overload. Also, as Nobel laureate Kenneth Arrow famously explained, information in the doctor-patient relationship is asymmetric. Nowadays doctors’ employers (often hospitals) sometimes have an incentive to withhold information if it is to their institutional benefit. Slate highlighted several anecdotes from people who were somewhat annoyed to learn – after the fact – about common side effects after they experienced them.
The answer to how much doctors should inform their patients is not straightforward. Some patients want more information than others. Some risks are so miniscule as to be almost nonexistent. Some patients are risktakers, while others are paranoid about any risk. For that matter, if told of rare side effects, some patients will experience them psychosomatically. Then there is the time it takes to explain risks and benefits, with accompanied handholding. The best advice for patients is to be skeptical and take the initiative. Ask questions and inform themselves about their disease or condition using the Internet.
Read more at Slate: Medicine, surgery, side effects: Is your doctor telling you enough about the risks?