Mike Kueber's Blog

June 7, 2012

Are doctors willing to share decision-making?

Filed under: Medical — Mike Kueber @ 10:40 pm

An interesting article in the NY Times recently discussed the difficulty in getting doctors to share decision-making with their patients.  According to the article, there is a movement in the medical community toward shared decision-making, but the movement is not succeeding because even affluent, educated patients seem to be reluctant to be assertive in discussing treatment discussions with their doctor.  If people with a sense of entitlement refuse to speak up, what chance is there that poor, uneducated patients will insist on their right to be heard.

Last week, I personally experienced an example of medical intimidation or patient deference.  After complaining to my orthopedic surgeon about a long-standing shoulder problem, he immediately directed me to have an MRI.  Before having the MRI, however, I was advised by a cardiologist friend and a yoga friend to have physical therapy (Rolfing) before having the ultra-expensive MRI ($1,500) or considering surgery.  When I asked the orthopedic surgeon (actually his nurse) whether he would refer me for physical therapy before having the MRI, she called back to say that he wanted me to have the MRI before he refers me to any therapy.

I reported this development on my Facebook wall and expressed my concern that there may be some sort of financial connection between my orthopedic surgeon and the MRI facility in the same building.  One of my friends suggested that I was being too cynical and that the doctor may have valid reasons for wanting to see an MRI before exposing me to physical therapy.  The problem was that the ortho’s nurse didn’t give me any of those reasons.  Also, I had already been exposing my painful shoulder to a panoply of physical activities for many months.        

So, what can I do?  Other than going to another ortho, my only option is to have the ultra-expensive MRI and then prevail on the ortho to refer me for physical therapy instead of having the ortho cut on me.  Although I don’t know whether the ortho has a financial conflict of interest in insisting that I have an MRI, I know for a fact that he has a financial conflict of interest in recommending physical therapy instead of surgery, especially if the physical therapist I want isn’t associated with his medical practice.

Furthermore, I have been told that the success of shoulder surgery is highly problematic, which provides even more reason for a surgical candidate like me to thoroughly review all alternative treatments prior to authorizing surgery.

The bottom line for me – earlier today I had my MRI and then after I return from my mid-June summer vacation in North Dakota, the ortho will tell me whether, based on his review of the MRI, to have surgery, drugs, or physical therapy.  I suspect that, because of my awareness of the physical-therapy option, I will be given the physical-therapy option.  But the option will arise only after I and my insurance company will have spent $1,500 on a diagnostic procedure. 

So much for the shared decision-making described in the NY Times article.



  1. So why didn’t you ask the nurse your questions, and ask the doctor? They can’t read your mind and will not always think to address your questions unless you share them. You are in the driver’s seat here. Your problem is elective. You can do nothing or something or a lot. You are not going to die from this. Be the empowered, engaged, knowledgable patient, listen to reliable resources not friends and collaborate with your providers. And ultimately if you can’t craft a good and trusting relationship with your orthopaedic specialist, find another one.

    Comment by Kate — June 8, 2012 @ 2:12 pm | Reply

    • Did you read my post, Kate? I didn’t do that because I was intimidated and reluctant to “question” the doctor. I get the impression that he would feel insulted that I was questioning the course of action that he had already determined.

      Comment by Mike Kueber — June 8, 2012 @ 2:31 pm | Reply

      • I am sorry you were intimidated; this should never be the case in health care. I like to think of my health care team in the same way I approach my auto mechanic. They all possess expertise I don’t have and that I need. I am hiring them to work for me. I need to tell them what is wrong and what is important to me as they share the possibilities for fixing what is broken. We negotiate the terms of our engagement. You are an expert in this conversation; no one knows better than you what your goals and preferences are. Doctors, nurses, mechanics, patients…we are all just similarly flawed and capable people. And I am a nurse, so I must know what I’m talking about : )

        Comment by Kate — June 8, 2012 @ 2:49 pm

  2. Kate, thank you for your service. I sometimes feel that nurses, teachers, and military officers are the last remaining professionals who act consistent with the creed of their profession. Although your analogy has some application, the difference between a doctor and a mechanic is stark. Medicine is a profession; mechanics is a trade.

    Comment by Mike Kueber — June 8, 2012 @ 7:01 pm | Reply

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