Doctors and patients may not always agree

Ethics Forum. July 2, 2007.

What do physicians do when patients want a different treatment?

It is not uncommon for doctors to encounter patients who do not agree with the prescribed course of treatment. A patient may not want to undergo an invasive test the physician believes is necessary, or the patient may not agree to a surgery. What is the best way to handle the situation? Sandeep Jauhar, MD, a cardiologist at Long Island Jewish Medical Center, shares his thoughts.

Question: What got you interested in the topic of patient reluctance (or refusal) to accept the doctor's recommendation?

Answer: This issue really captured my attention when I took care of Eric, a young man who came into the hospital with endocarditis. A doctor had suggested he have a cerebral angiogram, which, in itself, is a risky procedure. When Eric said he didn't want the procedure, it brought up memories of my own experiences when my wife was pregnant; we had asked for a treatment and had been refused it.

Q: How would you encourage physicians to evaluate their own decision-making when it comes to ordering tests or procedures that are not crucial, especially when patients are either reluctant or refusing to comply?

A: This is a complicated issue. We typically interpret patient autonomy as a patient's right to refuse treatment. But autonomy is the right to self-determination, and both patients and physicians are their own autonomous beings.