Clinicians urged to move away from ‘doctor knows best’ view

[Sly Saint]

Clinicians have been urged to move away from the “doctor knows best attitude” when diagnosing illnesses.

Experts said the “paternalistic, and often dangerous” view should change “to a more equal relationship” where patients’ lived experiences are taken on board.

It comes as a study led by the University of Cambridge and Kings’ College London found a patient’s view of their own symptoms or illness is not valued by the majority of clinicians.

Academics explored the value given by clinicians to 13 types of evidence used when diagnosing patients, including the likes of brain scans and patient views.

They surveyed 676 patients with neuropsychiatric lupus (NPSLE), which according to the researchers is “challenging to diagnose”.

Lupus is a chronic condition that impacts the immune system, causing problems with the skin, joints, kidneys and other organs.

NPSLE is when the condition affects the brain, spinal cord or other nerves, with symptoms such as seizures, strokes and psychosis.

Some 46% of patients said they were never or rarely asked for self-assessments of their disease, while 24% said their self-assessments were never or rarely consistent with their clinician’s.

Lead author Dr Melanie Sloan, of the Department of Public Health and Primary Care at the University of Cambridge, said: “It’s incredibly important that we listen to and value patients’ insights and their own interpretations of their symptoms, particularly those with long-standing diseases – after all, they are the people that know what it is like to live with their condition.

Clinicians urged to move away from ‘doctor knows best’ view (msn.com)

 

[rvallee]

Humility. What a concept.

Had to ask ChatGPT to be sure:

In ancient Rome, during a triumph, which was a lavish military procession celebrating a victory, it was customary for a slave to stand behind the victorious general. This slave had the role of reminding the general of his mortality, despite the day’s pomp and celebration. The slave would say something along the lines of, “Memento mori,” which translates to “Remember that you are mortal,” or “Remember you will die.” This practice served as a humbling reminder to the general that, despite his current glory, he was still human and susceptible to the same fate as all other humans. It was a way to keep the celebrated individual grounded amidst the adulation and honors being bestowed upon them.

Hopefully we can do this with less pomp, but I like the general idea. Heh, general idea.

What's weird is that MDs are generally trained to be humble. To know the limits of their knowledge. To admit their possible failings. To be aware that much of their knowledge is unlikely to be complete.

I wonder where it all goes wrong? Because if they're taught this stuff, they have to be taught the exact opposite as well, since it's what usually sticks out. I guess it just really depends on the situation, but clearly it fails mainly exactly in the situations where the humility should apply the most. Maybe it just fails in employment, when the demands of the job just throw out most of the flowery ideas and principles and the people in charge are constantly aware of how liable and expensive mistakes are, and always best covered up.

 

[Jonathan Edwards]

Humility is the key - and something drummed into me by my physician father but not something I always saw in colleagues to be sure.

But I don't think this study is the answer. The reason you do not ask patients for accounts of the symptoms they think are important is largely that those symptoms are often not very helpful in making a diagnosis. It is completely wrong to suggest that physicians should put more weight on 'lived experience' in making diagnosis if there is no reliable evidence that those experiences lead to a precise assessment of pathology and choice of treatment based on reliable evidence.

I am sorry but at least from the snippet posted this sounds like just the sort of psychosocial drivel we should avoid.