A young friend of mine recently experienced minor chest pain. Not the kind that made her want to call 911 immediately, but worrisome enough to land her before a triage nurse at the local emergency room reviewing her symptoms. The patient, a nurse herself, was promptly seen by the ER physician and after completing the requisite battery of chest pain examinations and blood work was discharged. The tests ruled out a heart attack and she was told to follow-up with her primary physician to determine other possible causes of the discomfort.
Of course as the pain persisted, she did what any well-informed health care consumer would do, she Googled the symptoms to find out what was ailing her. Within several clicks, she found the elusive diagnosis of which the ER doctor failed to provide: costochondritis, inflammation of the cartilage in the chest wall that can cause pain during breathing. Dutifully, she followed-up with her primary doctor and proclaimed the diagnosis within minutes of their interaction. Silently she scoffed at the need for further testing that included x-rays, echocardiograms and blood work, and (although she politely listened to the recommendations) she left with what she had gone to receive: a prescription in hand for pain relief. When the symptoms eventually faded, she felt reassured that her diagnosis had been correct and was relieved not to have been subject to a further battery of tests.
If either party (doctor or patient) distrusts the other’s judgment, decreased compliance with the treatment will often occur. Decreased compliance leads to frustration, aggravation and further erosion of the relationship.
A population of educated and interactive patients would certainly be ideal, but some of these behaviors may lead to over-demanding patients. The goal of patient education is to make knowledgeable health care decisions that are evidence-based and – more importantly – considered within a positive, reciprocal patient-doctor partnership.
As we transition into a patient-centric model of healthcare, it is no longer viable to take a paternal approach to treating patients. They must be allowed to know the differential diagnoses, risks, workups and treatments of each so that they can participate in further evaluation and treatment options. When thinking seriously about this, it seems obvious. It is the patient that is suffering, the patient that knows the symptoms best and the patient that will bear the brunt of any consequences.
While it would have been a good idea to make the patient aware that costochondritis was a possibility, it is also foolhardy not to completely evaluate the patient to rule out any more serious cardiovascular event.
It is fortunate for the patient that she was suffering from a more benign condition but not to rule out a problem that could lead to a fatality is exposing the patient to unjustifiable and unacceptable risks.
The patient-centric model of treatment is well illustrated here as the patient did the research and then consulted with a physician whereupon a professional evaluation was done. The patient was an integral part of the discussion and treatment decision and everyone was satisfied with the ensuing result.