Avoiding orthodoxy in understanding decision-making

The previous orthodoxy was paternalism. It’s my way, says the doctor, or the highway. The current orthodoxy – not stable yet but rapidly developing in that direction – is something called “patient-centered care.” Unfortunately, although we can define this term to our heart’s content, people tend not to read the textbook. What if a patient wants to be told what to do? What if a patient wishes to delegate all decision-making to their doctor, and the doctor thinks that’s not appropriate? What if a patient wishes to make all decisions themselves but clearly has no insight into their own health? Calling it “patient-centered care” solves none of these issues. 

What might help is to provide an instrument, like a survey, to a doctor before a patient’s first visit. Use this, we might say to a doctor, and you can help assess to what extent your patient wishes to be involved in decision-making. Or we might give this instrument to the patient. Then, even before the visit starts, we can know how paternalist, patient-centered, or something else either doctor or patient wish to be.

Those instruments don’t exist yet. Hey, let’s make them!