Consider the Pros and Cons of Patient Empowerment

Several recent articles have talked about empowering patients. The ACR has even offered a statement on the topic. And the discussion is an important one to be had, in my opinion.

Here are the two sides of the argument: On one side, patients may not fully understand what is told to them, and may not use that information as expected. Further, the information may only serve to increase anxiety in some. On the other side, more knowledgeable patients can make informed choices about what is or is not needed for them. And patients who understand why things are done, and how much they cost, can make reasonable decisions as to cost-effectiveness.

The first argument is criticized as paternalistic; the second as unreasonably utopian. I recall an ethical dilemma posed in medical school that is something like this: If you have a patient going on the trip of a lifetime next week, and you find out they have an important medical condition, do you tell them now (so they can decide to start treatment or choose to do something else), or wait until after they return to tell them (so they can enjoy their trip and not have anxiety).

The truth, as with many things, probably lies somewhere in between. Both sides have some merit, and both sides deserve criticism. To me, the fact is that some patients can mange that data better than others. But it does not have to be one or the other. The patient themselves can decide when they want the information. To me, withholding it from all, because it could be detrimental to a few, is overly restrictive. Perhaps we should offer greater information, and let the patient participate even in deciding what information they need.

Two other aspects of the discussion are important in radiology. First, patients who know test results and recommendations can ask questions about care, and can be sure they can get needed follow-up, or choose not to. This would reduce medical errors such as failure to follow-up on relevant findings.

Second, numerous studies have indicated that when patients feel they have a relationship with their provider and can better trust them, rates of accused malpractice decrease. Communication is important for patients to feel they have been cared for properly. In radiology we don't always have an opportunity to interact with patients, but if patients had more access to our reports, and could communicate with their radiologist personally, it could reduce malpractice claims.

I think more informed patients are better for the system as a whole, and would encourage sharing information, as I have here before. But there may not be a right answer to the issue for everyone and every patient. Each of us need consider carefully the pros and cons on each side.