Patient Autonomy: When We Don’t Agree

Believe it or not, patients ARE allowed to disagree with their doctors.  This concept is called patient autonomy, and addresses patients’ right to make their own decisions.  Sometimes it’s a REALLY tough pill for the doctor to swallow though!

I was in the ER today with a good friend of mine.  She was quite sick, and in a lot of pain.  We were blessed that the doctor was able to figure out what was wrong and gave her medicine that made her feel better.  However, she did not take his recommendation on what to do from there.  In spite of the strongest possible recommendation from the ER doctor (and me, too), she chose to do something else.  Her decision was the right one for her.

Doctors are taught to analyze symptoms, ask lots of questions, examine the patient, order tests, use the results to make a diagnosis, and then make recommendations for treatment based on that diagnosis.  We find it very logical to proceed from symptoms to diagnosis to treatment.

Sometimes our treatment recommendations don’t fit what’s going on with the patient’s life.  Sometimes the timing isn’t right.  Sometimes the patient can’t afford the recommended treatment.

Whatever the reason, patients have every right to choose NOT to take the doctor’s recommendation.  Sometimes what seems like the obvious choice to us is simply not workable for the patient.

As long as the patient is mentally able to make a complex decision and understands the risks of NOT taking our best medical advice, we are ethically bound to respect their decision.  Just because we don’t agree with it doesn’t mean we don’t respect it.

My friend is a subscriber to my blog and I know she will read this post.  That’s OK, because my writing is almost always prompted by what’s going on in my life.  My readers are patients (mine or someone else’s) and they need to know that their right to make their own decisions based on their values and life experience is sacred in medicine.

I might try to talk you out of making a decision if I don’t agree with it, but once the decision is made I will be the first to support your right to patient autonomy.

And then I’ll worry and fuss and call and pray until you’re feeling better!

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5 thoughts on “Patient Autonomy: When We Don’t Agree

    • Not always, Greg. We know risks and benefits, what might happen if the advice isn’t followed, vs. what might happen if it IS followed, but we ARE NOT the patient. Sometimes the patient just CAN’T do what the doctor recommends.

  1. The problem resulting in not following a doctors advice is risking that the doctor will say to the patient to go somewhere else if the advice is not adhered to.

    • That is a risk Dennis. I have a pretty high tolerance for patients disagreeing with me. As long as I’m comfortable that they understand I am not responsible for any bad outcome they might have avoided if they took my advice, I generally will continue taking care of them. Other doctors don’t have such a high tolerance and will dismiss patients if they don’t follow the advice. My personal opinion is that those doctors feel disrespected when the patient disregards their advice. The most dangerous combination is the patient who both ignores my advice AND blames others for problems. Those people make me very nervous.

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