In the current issue of the Medical Bridges newsletter, Dr. Rackner lays out the differences in perspectives between doctors and patients. She suggests that for doctors, harm means impairing the way patients' bodies work. For patients, harm also includes impairing the way their lives work. The failure to factor in a patient’s perspective results in unhappy patients who second-guess medical choices or fail to follow the treatment plan.

"Making a medical choice is like balancing the scales of justice," says Dr. Rackner, a board-certified surgeon. "When considering whether to take a medication or undergo an operation or get a full-body screening CT scan, you weigh the benefits against the risks. One side of the scale holds the possible ways the intervention helps, and the other side holds the potential harm. Doctors and patients have different ideas about what considerations go on the scale, and the gravity of each. Something that has minimal downside from the doctor’s perspective, like a follow-up blood pressure check may be a very big deal for the patient who feels a time crunch to complete a project at work."

Dr. Rackner lists some factors that patients may weigh more heavily than doctors when facing the every-day choice of starting a new medication.

Cost A patient with a good prescription drug plan on four medications still pays $60 out-of-pocket each month. In some families this $60 could mean the difference between paying the electric bill or not. Or the $60 a month for four medications could be put into the kids' college fund instead. Financial concerns lead to stress that can worsen the very medical condition the drugs treat.

Complexity All of us have too many things on the to-do list, and a streamlined health regimen is a priority for many patients. Some patients find filling, packing and taking medication to be quite burdensome. Doctors, on the other hand, are puzzled when their patients fail to take drugs properly.

Self-image Actions and health beliefs are intertwined. Vitamins may work, in part as a daily ritual that says with actions, "I invest in my health." For many people, taking medication is a daily affirmation that says the opposite, "I am vulnerable to illness."

Risk tolerance What about antibiotics for an infection that could be either bacterial or a viral, like gastroenteritis? Antibiotics won’t treat illnesses caused by viruses; however, failure to treat a bacterial infection with antibiotics may prolong the course of the illness. Whether or not to take a round of anitbiotics is a judgment call influenced by the willingness to take calculated risks.

Dr. Rackner says, "Patients have an important part in medical decision-making. It can take great courage for patients to speak up and tell their doctors what's important to them. I encourage them to do it. Ultimately, the best choices for patients reflect how treatment affects their bodies and their lives."

Copyright © Vicki Rackner MD, 2007

Vicki Rackner, MD, FACS, founder of Medical Bridges, serves the business community by helping health care consumers move closer to a doctor-patient relationship that is a collaborative partnership. Her focus is where the "rubber meets the road" - in the clinic exam room where plans are made and in the patients' homes where the plan is carried out. She suggests to patients exactly what to say and what to do during an encounter with a health care provider so they get the health care they want, need and deserve. Dr. Rackner is an author, speaker and consultant.

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