Mock: should a physician be an advocate for patient's rights

[Guest Emila]

I got this question at my Queen's interview. I don't think I handled it very well. I talked about the importance of autonomy and that the final decision should be the patient's even if I didn't agree with what they chose.

 

Was anyone else asked it?

 

What is your opinion?

[Guest macdaddyeh]

This is a good question and I have recently thought about it. I would say that a doctor can be, but not necessarily should be, an "advocate" because that implies a value judgment or that something is systemically wrong and that a patient's rights must be demanded and upheld. I think that there are now actual paid patient advocates in many hospital or community heatlh care settings so that a doctor need not be concerned with advocating. In a similar vein, it is well understood that in the legal field lawyers are told NOT to be advocates.

 

The bottomline is that in these "mocks" one must realize that there is not necessarily (but not always) a right or wrong answer. One simply must be able to argue WHY one makes the point they are making.

[Guest Emila]

Macdaddyeh:

 

Thanks for showing me a different perspective.

 

You mentioned that a doctor being an advocate for patient's rights implies that patient's rights must be upheld. I thought the patient always has the final say on whether they want a certain treatment or not. Doesn't this mean that the patient's rights are usually upheld?

[Guest macdaddyeh]

Thanks for your response..

 

When I stated that advocacy implies that "a patient's rights must be demanded and upheld" I mean that a physician should not be in charge of carrying this responsibility. Ultimately, as you stated, the patient makes the final decision.

 

Ie. 16 yr old girl comes and wants to discuss "options" for her pregnancy. I say you have these legal options: terminate, keep and raise, adopt.

 

Ultimately, however, the female (and partner and/or parents) must "advocate" for that patient. As a doctor I can only facilitate the decision-making process NOT advocate one way or another because that has its own legal/ethical implications.

 

Keep in mind please, the above is only one possible scenario or example; many others have been discussed in other posts.

 

Finally, public health advocacy is something I DO believe in (ie, province-wide no-smoking regulations) b/c these initiatives are in the interest of the public good, but individual patient advocacy is a tricky concept.....but isn't everything in medicine these days:p

[Guest UWOMED2005]

Another avenue to explore would be the physician's role as "gatekeeper" - ie protecting public resources, as it conflicts with a patient's right. I wasn't too familiar with this idea when doing my interviews, but I wished I had been.

[Guest grandmellon]

I believe that Dr's should advocate for a patient if they are not receiving the type of treatment which they want. In this I mean that the doctor should support a client's decision for treatment if it is made on knowledgeable grounds (knowing the pros and cons of treatment).

 

I'm not sure if this will make sense to people but... {An example is the old man who needs to start getting dialysis treatment for his kidneys. His family wants him to not have the treatment because it prolongs his suffering. But the patient wants to have it when discussing it with the doctor. A day later the patient rescinds on what he says and says he does not want to have the dialysis... is this because the family coerced their father into not having treatment? I think if the old man is cognitively aware and competent the doctor should go by what he says... but if the doctor sees that the client does not appear to not want dialysis the doctor should probe further and ask why he changed his mind... If the client says he changed his mind because of the pressure from his family the doctor should advocate on his behalf... } Ahhh forget that insert.. i dont think it made any sense... it's getting late |I

[Guest macdaddyeh]

Your point does carry some weight. I think that in the end a doctor can be an advocate, but it depends on the circumstances, because doctors simply don't have the time or energy to be an advocate all the time. You provided a probable example.