Patients’ preferences paramount
Patients’ preferences are often misinterpreted or ignored in treatment decisions, leading to a “silent misdiagnosis”, according to a new international study. Albert Mulley argues a doctor cannot recommend the right treatment without understanding how the patient values the “trade-offs”.
Patients’ preferences are often misinterpreted or ignored in treatment decisions, leading to a “silent misdiagnosis”, according to a new international study.
Albert Mulley, from the Dartmouth Centre for Health Care Delivery Science in America, argues a doctor cannot recommend the right treatment without understanding how the patient values the “trade-offs”.
Making an accurate medical diagnosis remains a source of professional pride for many physicians, say the authors, yet evidence suggests that the problem of “preference misdiagnosis” is high.
According to the authors, there are often gaps between what patients want and what doctors think they want.
In one international study, doctors believed 71% of patients with breast cancer rate keeping their breast as a top priority, but the figure reported by patients was just 7%.
In a study of dementia, patients placed substantially less value than doctors believed on the continuation of life with severely declining cognitive function.
Evidence also shows patients often choose different treatments after they become better informed about the risks and benefits, say the authors.
One study also found 40% fewer patients preferred surgery for benign prostate disease once they were informed about the risks of sexual dysfunction.
Ensuring patients’ preferences are not misdiagnosed is not as simple as asking the patient what he or she wants, explain the authors. They add it requires three steps: adopting a mindset of scientific detachment; using data to formulate a provisional diagnosis; and engaging the patient in three steps of shared decision making; team, option and decision talk.
