Kevin Pho, MD
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I recently saw two patients in my primary care clinic, each with new-onset hypertension.
The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options
for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on what to do next. He considered
and appreciated my input but made it clear that the ultimate decision was his.
The second was an elderly gentleman in his 70s. Again, I discussed the various management approaches and then gave my opinion
on what we should do. In contrast to the other patient, he said, "I want to do whatever you suggest. After all, you're the
doctor."
As a publisher of a social media health Web site, I've observed closely the growth of the patient empowerment movement, facilitated
by the Web making health information more accessible. According to the Pew Internet and American Life Project, 80% of Internet
users go online to research their health, and this effort gives patients a greater voice in their care.1 Paternalistic decision making that traditionally drove the doctor-patient relationship slowly is being replaced by shared
decisions. But not all patients embrace their new decision-making role. In a recent study from the Journal of Medical Ethics, researchers interviewed more than 8,000 patients. Almost all wanted doctors to offer choices and help consider their options,
but two-thirds preferred that the final medical decision to be left to the physician.2
According to Farr A. Curlin, MD, an associate professor of medicine at the University of Chicago and one of the authors of
the study, "the data [say] decisively that most patients don't want to make these decisions on their own."3
There is a spectrum of how much physician involvement patients want. Some may want physicians only to suggest and inform but
leave the ultimate decision to them. Others prefer doctors to have the final say.
The only way to know a patient's preference is through a continuous relationship where that comfort level can be developed
over time. After several encounters, a clinician should have a sense of how much, or how little, direction a patient needs.
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