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Originally Posted by Rich_in_Tampa
Well said.
I involve patients in these decisions all the time. I tell my students that I never intentionally practice defensive medicine, but I often practice defensive documentation.
"Discussed risks and benefits of CT including incidental findings leading to further testing, small possibility of overlooking bleeding or other serious conditions if we fail to do this test. Good understanding was expressed and pt prefers to omit the test with good insight. To call at once for any unexpected symptoms."
I have no idea if that would protect me (or the patient), but it's how I do it (stress tests, PSA test, and lots of others are common examples).
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I'm impressed that you take this approach with all of your patients. I do have a question - do you find that there are a large number of patients who wish to completely abdicate responsibility to you and not be involved in the process?
Returning to the concept of EBM, there does seem to be a difference in mindsets between the medical and scientific fields. Working with MD/PhDs in a research environment, I have consistently heard complaints about both the thought processes and decisions made by pure MDs (gut feeling as opposed to evidentiary decisions as described in the above article). Of course, you generally hear more of the negative stories than positive stories.
I'm sure some of this is from training and environment, but I also wonder if this also has something to do with the type of people the field attracts?
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