Physicians shouldn't casually dismiss patient mistrust of treatment plan

Regarding "Doctors and patients may not always agree" (Column, July 2): I read this article with keen interest and agreed with all the sensible advice from Sandeep Jauhar, MD, PhD. The problem however is far deeper, widespread and troublesome than an occasional honest disagreement between the patient and doctor as to what is necessary treatment.

There is a serious problem across the globe about trusting doctors, whether they have your best interest in their hearts or are primarily motivated by other considerations.

In India, patients routinely will not give but limited information lest the doctor gets wrong ideas about the scope of treatment. Hospitals are often euphemistically referred to as butcher houses to give vent to the deeply held conviction that surgeons often operate unnecessarily.

There is a widespread fear among U.S. teenagers that if one buckles and gives in to seeing a psychiatrist one will be immediately put on powerful psychotropic medications. Until just two decades ago psychiatric patients often stayed for years, and sometimes for life, in institutions because of routine abuse of involuntary commitment laws. ECTs, seclusions and restraints, once a staple of psychiatric hospitals, have become a rarity, thanks to the evolving consciousness that it pays to resist overzealous treatment.

And the problem is not just in the field of psychiatry.

A few years ago, in a renowned university hospital, a cousin of mine, also a doctor, had extreme difficulty in preventing doctors from doing brain surgery upon his mother's alleged pituitary tumor, which was actually an edematous swelling due to psychogenic polydipsia. As a rule, doctors are in severe denial over how financial motives and other vested interests influence their medical conduct.

When a patient disagrees with you, the first assumption should not be on how to convince the patient to change his mind about his bad decision. The physician must do some soul searching whether the patient is not more medically and economically correct on the matter than the doctor.

Surendra Kelwala, MD, Livonia, Mich.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/08/13/edlt0813.htm.