Monday 15 February 2010

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Health Report 28 min 1 speaker 8 chapters transcribed 3 days ago

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Transcript generated automatically by AI and may contain errors.

What is the central premise of putting patients, not doctors, at the centre of medical consultations?

Norman Swann 0:00

Hello, I'm Norman Swann. Welcome to the Health Report. In this program, someone who's been neglected for a long time. Someone who you might think is actually quite important. Someone who helps to pay the bills of health professionals. And that's the patient. You and me, basically. Today's programme's quite radical, really. It's about putting you and me at the centre of a medical consultation, not the doctor. Lots of health professionals think they do that, but in fact research suggests they don't, partly because doctors, nurses and others bring their own baggage, and it can get in the way. And there are often important decisions to be made, for instance about whether you should have a test or an operation or a medication.

Norman Swann 0:42

Sometimes we're bamboozled by what's been said to us by We don't know what questions to ask, and the doctor fails miserably to find out what we think and where we're coming from. And that failure, as you'll hear, leads to prescriptions that don't get filled, and even when they are filled, sit on shelves and aren't taken, and that's at enormous cost to the Australian taxpayer. It's not that we're idiots and don't appreciate why the prescription's being given. It's just that there are lots of reasons why a medication isn't taken, and maybe if our views were taken into account during the consultation, we'd be more effectively treated either with medications or without them. This is the passionate research interest of doctor Victor Montori, who is professor of medicine at the Mayo Clinic in Rochester, Minnesota.

Victor Montori 1:29

The fundamental reason is we're interested in evidence based medicine and how do we bring evidence based medicine to the practice. And this means taking into account the two principles of evidence based medicine. One is that the better the research, the more confident the decisions will be. So how do we bring the quality of the research to bear when people are making decisions? And the second issue was how do we incorporate patient values and preferences in decision making? Without that you're not practicing evidence based medicine.

Norman Swann 1:59

So it's all very well having the randomized trial that tells you this drug's better than that drug or this drug's better than exercise, but somebody actually might prefer to go down a route which isn't quite according to the best possible standards but suits them better.

Victor Montori 2:11

Well two things. One is the randomized trial will find what's better for the average patient and by how much is that better. And that's going to be a very helpful piece of information to make a decision. Yet the outcomes that are considered better may not be considered better or desirable for everyone to the same extent. And the burdens of those treatments may not be considered as easy to tolerate for different people. And so for some people the burdens and costs that will take them to those desirable outcomes are too much and they may not find the intervention desirable. For others, the outcomes will be very enticing and they'll be uh ready to tolerate burdens and costs that are unacceptable to others.

Victor Montori 2:49

So preferences actually play a key role in designing therapies. So

Norman Swann 2:52

for people listening to us who put themselves in the role of patient, they'd say, Well, that sounds right. People listening to us who might be doctors or nurse practitioners or something like that might say, Well, I spent a lot of time talking to people about their preferences. But your research, what sh we'll get on to in a moment, suggests that while they think they might be doing a good job, they may not necessarily be doing so.

Victor Montori 3:11

Yeah, and there's this idea which is very depressing that, you know, people talk about the art and the science of medicine. And the recognition I think today is that our art is not that crafty and our science is not that rigorous. And when it comes to clinical practice, I think we educate patients a lot. Well let's put it this way, we teach patients a lot, but patients learn very little. And the reason they learn very little is we are teaching them out of context.