Public Health Law Map - Beta 5 - Medical and Public Health Law Site

factual basis for medical decision making.
A careful discussion of the risks of the proposed treatment may cause the patient to
reconsider the actual severity of his or her problem. The physician must be open to
indications that the patient is growing uncomfortable about undergoing the proposed
treatment. Synergistic misunderstandings can arise when the physician overestimates
the severity of the patient’s problem and recommends a major intervention. The
patient then believes that the problem must be serious because the physician has
recommended such a major treatment. Unless the physician carefully questions the
patient after the treatment has been proposed but before it is carried out, the patient’s
belief that he or she must be sick because the physician wants to treat him or her as
sick will not surface until the patient is injured.
7. The Patient’s Expectations
Unreasonable expectations are at the heart of most medical malpractice lawsuits. It is
important not to overstate the benefits of a proposed treatment, most critically if the
treatment is for a minor condition or if there are effective alternative treatments. It is
simple enough for a physician to avoid overstating the benefits of a treatment in
talking with the patient. It is much more difficult to combat the unreasonable
expectations that patients get from the constant news about medical breakthroughs.
With patients treated to the spectacle of routine heart transplants and perfect test-
tube babies on the evening news, it becomes very difficult to explain that heart
disease is a chronic illness without a quick fix and that a certain percentage of all
infants have some type of birth defect.
A physician must assume that every patient has an unreasonable expectation of the
benefits of medical treatment. Whether these unreasonable expectations arise from
overly optimistic news reports or medical advertising, they must be rooted out and
dispelled. The physician must specifically ask the patient what the patient expects the
treatment to do and believes the risks to be. This will allow the physician to deal
explicitly with the patient’s misinformation rather than blindly giving the patient
more facts to confuse. In a variant of Gresham’s law, it is clear that bad information
drives out good information by increasing a patient’s misperceptions. Patient
misperceptions should be documented and a notation made about the correct
information given.
Even when the physician and the patient agree on the severity of the complaint and
the risks of the treatment, they will not necessarily make the same decision about
undergoing the treatment. Physicians and patients have different risk-taking
behavior, and patients differ in their risk-taking behaviors. Some are gamblers, and
some keep their money under the mattress.
One patient will present with chronic pain and be satisfied to find out that it is only a
bone spur, having assumed it must be cancer. Another patient with the same problem
will want the physician to try to correct the spur surgically, despite the risks of
anesthesia and potential disability. Patients who do not like to take risks are poor
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