Friday, June 05, 2009

Avoiding dictatorial professionals

Donald M. Berwick is a Harvard pediatrician, and he advocates
giving patients what they want.
Q. Tell me about your views on “noncompliance.”

A. I think “noncompliance” is a control word, a power word, and we need a slightly different one. “Compliance” means I order and you either do it or not; you obey. Patients live in their bodies and may know more than the person who prescribes or does their procedure. They may know better about what is going on in their body and about the optimization of their own life. I think people who aren’t taking their own medicine are telling us valuable information about their medications and their life, and we need to listen to them.
A lot of physicians have a different attitude. They want to drop you if you show any signs of noncompliance. Other professionals have the same disease, including lawyers, optometrists, dentists, etc. Usually they will withhold info in order to try to prevent you from making an informed decision.

To my astonishment, I have learned that many otherwise intelligent people do not mind being manipulated in this way. Some of them don't seem to even realize that they have a choice about their own medical care.

Meanwhile, there are physicians who regularly complain about patients doing their own research on the web. These patients come in with there own diagnosis, and know what drug prescription they need. You might think that physicians would be happy about this, but some of them hate it.

A good way to test your professional's attitude is to try refusing his advice. Wait
for him to recommend a treatment, and then tell him that you are going to do something different instead. If he recognizes that you are in control of your own life, then he will accept and cooperate with your decision. If he tries to stop you, then you should fire him immediately.

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