Doctor-patient relationship – an idealised concept? (2)
Pandya has described an ideal situation in an idal society. Unfortunately we are a long way from this Utopia, in which age there would be no need for journal entitled Medical Ethics. In society as it exits, we cannot fault any patient who wishes to have a second or even third opinion without the permission or knowledge either of his general practitioner or his private consultant.
We must respect the patient’s autonomy. In order to understand a patient’s behaviour, it is best to put oneself in his position. Can one blame a person who has been advised an operation for wanting confirmation from one or two other doctors as to its absolute necessity? What about a patient who is suffering form a chronic ailment ans has not found relief from the treatment prescribed? Malignant cancer is another area where the patient may feel justified in seeking another medical opinion.
No doubt, as Pandya states, ‘multiple medical opinions breed confusion’, but just as an individual may shop around when he is purchasing anything for himself or his household, I feel that it is the patient’s right to do the same where his own health is concerned.
It certainly makes it easier for the last consultant the patient visits if he brings along with him all the reports and investigations performed on hin but it is not always feasible to bring a letter of reference or permission for examination by the last doctor who examined him.
As regards the last paragraph in the same essay , Pandya does not make clear what he would do in case the previous surgeon treating the patient refuse to grant permission to him to examine the patient. Will Pandys refuse to examine and advise the patient? what about the confidence a patient reposes in his doctor? Would it not be a breach of confidence if a doctor sends all relevant notes about the patient at the request of another doctor without the patient’s written consent?
- Pandya S: Doctor-patient relationship. Medical Ethics 1995;3:23-24.
Samuel J. Aptekar, P.O. Box 1005, Nazareth Illit Code 17110, Israel