Checkup

Vital Signs

Partners in care

Dr. George Bartley

Dear Readers,

"What are my options, doctor?" After hearing the patient describe his symptoms, performing an examination, obtaining laboratory tests and X-rays, and making a diagnosis, the physician must now answer the most commonly asked question: "What are my options?" (A related query — "Doctor, what would you do if I were your relative?" — probably runs a close second.)

I often tell patients that my role is primarily that of an educator: to help them understand what has gone wrong with their body and to provide the necessary information to allow them to make the most appropriate choice about treatment. Ideally, the patient and her physician should be partners in dealing with an illness. Patients should not feel that they must battle with disease without guidance and support, but neither should patients expect to relinquish the responsibility for their health to their physician, a nurse, or other health-care providers. Similarly, doctors must be honest with their patients about diagnosis and prognosis and must work with them to achieve the outcome that best serves the patient's needs. It has not always been this way, however.

In ancient Egypt, for example, a physician had the latitude to determine whether or not to intervene in a patient's care. According to the 3,700-year-old Edwin Smith Surgical Papyrus, a doctor had three options when dealing with a sick patient: to treat the illness (when he anticipated that a cure was likely or that the patient would recover regardless), to contend with the illness (if a cure seemed unlikely but palliation was possible), or to avoid treatment altogether (if the case seemed hopeless). It was the physician's call.

The relationship between doctors and patients is more of a two-way street nowadays, but the relationship, especially between male physicians and female patients, has been less than equitable and transparent even in relatively modern times. Up until the early 20th century, for instance, well-to-do women in Asia used porcelain figurines to show the doctor "where it hurt" in lieu of a physical examination. In this country, it was not that long ago when physicians did not feel compelled to disclose bad news to a woman, but rather discussed the diagnosis and options with her husband. And even today, eliciting an accurate history and performing a standard physical examination can be challenging in countries whose customs require women to be subordinate and to cover themselves completely when outside the home.

Nowadays, patients usually expect their doctors to "do something" when a disease has been diagnosed, and most physicians are reluctant to let the tools at their disposal lie idle. We might learn from the Egyptians, though, that intervention is not always the best option. Recognizing that each of us is mortal, we need to appreciate fully the pros and cons of the choices we make regarding treatment, palliation, or avoidance, especially towards the end of life. Such decisions can be made only when patients and their health-care providers are true partners in care. We at Mayo Clinic are committed to serving our patients with trust, honesty, and respect. Thank you for that privilege.

Sincerely,

George B. Bartley, M.D.
Chair, Board of Governors