Should Patients Be Allowed to Direct Their Own Care?

Some people have suggested that one way to prevent the wasteful costs of healthcare is to have a menu of treatment options, with their costs, that is presented to the patient. For example, when you are admitted to the hospital as an inpatient, the physician typically orders tons of tests, medications, and nursing orders. Most often you will likely have an intravenous fluid running, be on a stool softener, multivitamins, pain medications, daily blood work, etc. But all of these treatments and medications have a cost.

When I was a resident we had an attending on rounds who always would ask us if we knew what the costs were of every drug or treatment that we ordered. Most of the time we did not know. We ordered what was commonly ordered. We did not typically try to find out the cheapest alternative. Occasionally we would have a patient who insisted to know the cost of every medication they were receiving and all of the cheaper alternatives.  Wouldn’t it be great if we could provide a menu of treatment options and their costs to every patient and allow them to direct their care?

There have been many times in my career where I felt that was the case. However, being in the hospital and seeing a menu of medications and their costs is not like going out to dinner and choosing off of a menu. Even though we describe the patient as the “consumer,” they really are not the consumer. They are the patient. They must consent to treatment and can choose treatment options, but they cannot “direct” their own care. If they could direct their own care then doctors would not be needed. As I’ve mentioned previously doctors are licensed to practice medicine and usually are board certified in their specialty. They have been trained for at least a decade to become licensed. Thus they direct patient care. Patients can choose treatments, but doctors ultimately are responsible for what happens to the patient.

In many ways, a doctor is a parent and a patient is the teenager. The teenager is almost a fully functioning adult, able to make their own decisions, but they are not old enough to be independent from the parent. A good parent makes decisions with consultation from the teenager. And ultimately the parent is responsible if anything bad happens to the teenager. There are many adult concepts a teenager cannot understand without extensive explanation. Even after such explanation they still may not understand. Thus it is not feasible to explain the pros/cons of every treatment or medication, the potential side effects, sequelae, the recent literature on outcomes, and the whole volume of information out there on every treatment and drug. Doing so would be unacceptable, and, even if you did do this, the patient may still not understand everything.

While a menu of treatment options and their costs may sound attractive in theory, it simply is not feasible and would clearly highlight that the patient is a patient and not a consumer.

6 comments to Should Patients Be Allowed to Direct Their Own Care?

  • That level of condescension is one reason so many people put off going to the doctor when they really should. I’d rather stick with over the counter treatment, nutritional and alternative therapy and a chiropractor who realizes he’s human than go to your practice unless I was on the verge of death.

  • Stephan Zimmermann

    Since doctors generally work with or are on the staff of profit-making hospitals, and in addition are part of the biggest union monopoly in them U.S. – the AMA – it is not necessarily in the best interests of the patient to be treated as a child under authoritarian auspices.

    The result is that too many doctors have become businessmen (or women) who have forgotten their original oath: “I will use regimens for the benefit of the ill…”

    Those regimens have to be effective, not the most expensive! They even might be natural or holistic remedies.

    From personal experience, physicians throughout the world, from Argentina to the U.K. to Bangkok, concentrate much more on the emotional and psychological well-being of their patients than on the rapid dispensing of often unnecessary medicines or other regimes..

    A qualified doctor should have the experience and judgment to advise a patient on the recommendatons and alternative options rather than relying on the dictates of the AMA.

  • [...] Should Patients Be Allowed to Direct Their Own Care? Posted on November 1, 2008 by coptermedic From Citizen Economists: [...]

  • William

    I totally agree with both comments., All those holistic and alternate treatments are obtainable from the local GNC-type store.

    Dr. Google is your friend and will never let you down.

  • Jan Holland

    In the Netherlands(NW-Europe) the unions of (medical) specialists have defined a number (around 30.000 :-) of Diagnoses-Treatment Combinations (DBC’s in Dutch). They get redefined every 5 years after statistical analysis of about 1000 treatments in that period. The insurance-companies ask the hospitals what their prices/results are and send their patients to the cheaper _and_ most successfull (hospitals). The doctors are employed by the hospitals. The government (is about the same as the social insurance) defined that “everybody” is entited to get treated for about 1200 Euro for about 95% of all DBC’s. Many hospitals are not profitable, mainly because their administration is/was not organised to adnminister costs according to DBC’s.

  • that is a great analogy. similarly I have retired physicians in my family. I ask them what doctors I should go to, but I also check website just to make sure. I think there are two levels of information, peer to peer that is one patient to another gives you comfort and information from experts, e.g. physicians gives your confidence

    I suspect you are supportive of patient comment sites. for example – it’s where I posted about my experience with kidney stones.

    I hope this helps others that might be facing the same procedure

    But like anything you need to take information with a grain of salt. sorry I didn’t mean to make a pun there about the kidney stones and salt.

    all the best

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