Risk Savy By Gerd Gigerenzer

Patient's decision-making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively, emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians. Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.

"Children, young people, their parents or legal guardians, and health care professionals in all settings make decisions about medicines based on sound information about risk and benefit. They have access to safe and effective medicines that are prescribed on the basis of the best available evidence" (Caldwell, 2013).

"Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error…" (John Hopkins Medicine). This soaring number has caused medical errors to become the third leading cause of death in the United States. For many people, medicine seems foreign and unknown. People who have lost loved ones due to medical error desperately look for a reason, and many times that blame falls upon doctors. Media has put a negative connotation on doctors as well, causing their reputation to plummet whenever a hospital procedure turns badly. A renown surgeon and author, Atul Gawande, uses his knowledge and experience to give people a new perspective on medicine. In the article "When Doctors Make Mistakes," Gawande uses rhetorical appeals: ethos, pathos, and logos to prove the need for a change in the medical systems and procedures. He analyzes how the public looks at doctors, giving a new perspective to enlighten the reader that even the best doctors can make mistakes.

Blendon, R. DesRoches, C. Brodie, M., Benson, J. Rosen, A., & Schneider, A. (2002). Views of practicing physicians and the public on medical errors. New England Journal of Medicine. 347, 1933-1940.

Atul Gawande in his article “When the Doctor Makes Mistakes” exposes the mystery, uncertainty and fallibility of medicine in true stories that involve real patients. In a society where attorneys protect hospitals and physicians from zealous trials from clients following medical errors, doctors make mistakes is a testimony that Gawande a representative of other doctors speak openly about failures within the medical fields. In this article, Gawande exposes those errors with an intention of showing the entire society and specifically those within the medicine field that when errors are hidden, learning is squelched and those within the system are provided with an opportunity to continue committing the same errors. What you find when you critically analyse Gawande, “When Doctors Make Mistakes essay is how messy and uncertain medicine turns out to be. Throughout the entire article you experience the havoc within the medicine field as the inexperienced doctor misapplies a central line in a patient.

To argue the first premise, he appeals to common knowledge that doctors hold their occupations because they are more knowledgeable in a medical context on the options for improving health and longevity. With this in mind, he then establishes that individuals who consult physicians do so in order to prolong their life and improve their well-being. By establishing these foundational premises for paternalism in a medical context, Goldman can now argue that given a patient that is determined to be acting out of line with his true values and his actions might result in harm that is severe, certain, and irreversible, it is the physician’s professional to override the patients’ immediate rights in order to preserve that patients’ more long-term desires. But how can the physician determine whether the patient is acting in line with his true values in the case of withholding medical information from the patient?

Katz states, “the conviction that physicians should decide what is best for their patients, and, therefore, that the authority and power to do so should remain bested in them, continued to have deep hold on the practices of the medical profession “(214).

Goldman based his beliefs on the fact that all doctors have knowledge of treatments; however in American society, not all physicians follow the same practice or know of every solution to a patient’s illness. In John Wennberg’s reading, Wennberg criticizes the irrationalities in the Agency for Health Care Policy and Research (AHCPR) and comprises it in two key points: the weakness of poorly tested medical theories and a physician’s preference of treatment and position dominating over the choice of a patient (1, Wennberg, CC 2015 p. 21). Wennberg developed the idea of outcomes research, which is the results of research in the health care system based on patients and population. Urologists were interviewed in different locations of Maine based on the different practices on prostate disease. Some physicians recommended men to receive surgery earlier in order to improve health and to have a longer lifespan. Result showed that this practice was not only an untested hypothesis, but it

Our health system is, well, complicated. We have many guidelines in place to protect both patients and providers, but there is always some kind of situation where we are left to question whether following the rules was the best path for everyone involved. Beyond this, some circumstances can leave us with conflicting guidelines. Many times, health professionals are left to make a judgment call. This kind of “best guess” system is no problem when we are making decisions about our own health. We are the ones that will live with the consequences. However, as health care professionals we are making decisions about how other people will be cared for, which has much more widespread consequences. As much as we would like

Physicians were not to be questioned about their choices, and patients were not to offer their “own crude opinions (Carrese, pp. 693).”

Dr. Simon Flack believes the medical establishment needs to do more to ensure that doctors are provided with evidence for any real change to come

In an article published by Consumer Reports in 2011, 660 physicians were questioned regarding “What Doctors Wish Their Patients Knew.” (Chesanow, 2014). The topic that gained first place in the list was concerning patient noncompliance to medication and treatment. (Chesanow, 2014). It is reported that about 50% of the medications are not taken as prescribed by clinicians (Brown & Bussell, 2011). As a matter of fact, the number of noncompliant patients have significantly risen to levels considered as an epidemic (Chesanow, 2014).

Many studies have linked implicit biases to differential treatment recommendations to patients. One study observed that an implicit non-preference for blacks was correlated with a decreased likelihood of treating them for thrombolysis, while another study observed that black children are less likely to receive opioids for pain relief (Doyle). In my future practice, I may implicitly assume that certain patient populations are less likely to adhere to treatments, be able to afford treatments, or have access to certain treatments. Therefore, I may not offer certain treatment options because I implicitly assume that they will not utilize it. As a consequence of not receiving appropriate treatment, these patients may experience increased preventable morbidity and mortality. Additionally, if the patient is aware of the standard of care, this may make them extremely dissatisfied with their care, leading to a weakened doctor-patient

Phases three and four, testing the model then expanding, focus back on consent for whether explicit consent is needed by a patient for a physician to use the predictive model on their case. To this the authors argue that the patients do not have to know who or what their physician consults with. Also, if the patient was able to opt out, their decision might unfairly give them priority over other patients is situation where they are in need of a transplant or in need of the final bed in the

If patients don’t get the right to choose, they might refer to illegal methods to die or even commit suicide.