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Commentary

Who's In Charge?
Marc Siegel, MD, Washington Post, 7-11-06

Siegel, a physician, argues that it is the ultimately responsibility of patients to control their treatment, not the doctor. At their best, doctors simply act as guides or informants that help patients navigate their way through the healthcare system. While he admits that it can bruise his ego to have a patient question his medical judgment, he urges his readers to be informed and take charge of their health.

Whatever the source of a patient's information, a physician is most effective when he or she isn't defensive, but acts as an interpreter of information and guide of treatment, leaving the ultimate control to the patient.

That's not just my opinion.

A 1999 Canadian research review of 22 published studies focusing on crucial aspects of doctor/patient communication, including "clear information provided to the patient, mutually agreed upon goals, an active role for the patient, and positive affect, empathy, and support from the doctor," found that these features led to patient satisfaction and adherence to treatment plan. And the studies showed a "generally positive effect of key dimensions of communication on actual patient health outcomes such as pain, recovery from symptom anxiety, functional status, and physiologic measurement of blood pressure and blood glucose."

Many studies have shown a link between poor patient understanding about his or her health (that is, poor health literacy) and poor outcomes. In 1999, a committee of the American Medical Association's Council on Scientific Affairs tied health literacy to improved health outcomes for multiple diseases. A 2002 study in the Journal of the American Medical Association linked the use of patient self–management education programs with improved outcomes in many chronic illnesses.

On their own, many of my patients have developed self–education skills, some of which have led to astute self–diagnoses.



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