"Some time ago, a judicious and considered surgeon was describing the complex operation required by our mutual cancer patient. The operation necessitated a large incision, prolonged anaesthesia and possibly a second operation. Then there were the long-term complications, including pain and disfigurement. The patient was elderly and somewhat vulnerable to begin with, so just listening to the plan filled me with consternation. So, without telling him how to do his job, I asked politely: What does the patient want?"
"His question needed no reply because I knew that he knew that, in keeping with the evidence, many of our shared elderly patients emphatically chose quality of life over longevity. But I had reason to wonder if the patient had told the surgeon the same things she had told me over a consultation that had taken the best part of an hour."
"This made me reflect on the information asymmetry between what patients told their oncologist or GP, and what they told their surgeon, which leads to substantially different treatment plans, neither wrong but each consequential in its own way. It has been traditionally assumed that patients expect the listening part of their care to be undertaken by physicians and leave the doing part to surgeons."
A complex, high-risk operation for an elderly cancer patient involved significant immediate and long-term harms, including pain, disfigurement, and possible loss of independence. The surgeon assumed the patient wanted to live at all costs, while the patient prioritized quality of life and remaining independent. A detailed consultation revealed patient values that differed from the surgeon's assumptions, exposing information asymmetry between what patients tell physicians and what they tell surgeons. That asymmetry can produce different, consequential treatment plans and reflects public perceptions linking surgical technical skill with weaker bedside manner.
Read at www.theguardian.com
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