This is from a blog by a family practitioner who identifies herself as a dinosaur but “not dead yet.”

She’s also written a book on the subject, Declarations of a Dinosaur, published August 4, 2009. She gives little away about herself on her blog, but Amazon.com provides this bio:  “Lucy E. Hornstein, MD has been a solo family physician in the Philadelphia suburbs for 18 years. She was born and raised in Washington DC (which has left her with a deep and abiding apathy for all things political) and attended college outside Boston before coming to medical school in Philadelphia, which, she has discovered, is a black hole. (No one born here ever leaves; no one who moves here ever leaves.) She has been blogging since August 2006 when she assumed the persona of “#1 Dinosaur,” a nod to the impending extinction of primary care.”

On this website, TPR, we write a lot about the doctor-patient partnership. It is our goal to be clear that it is not possible for it to be a 50-50 partnership because one of the partners has been to medical school and the other has not—-and may feel rotten, besides.

That said, it still is a partnership, each doing the best he or she can.  Let’s also remember that it often is the patient who gives the doctor the diagnosis, although not in Latin. Repeated takings of the history of the problem may enable the patient to refine a pattern or spot a symptom which, at the time, meant nothing. So, patients are no slouches in helping out in the diagnostic department—-they just may be not be expected to.

Many doctors have argued that “informed consent” is an ideal, not a reality.

This marvelous woman is making the same point but more bluntly.

Don’t give up on your partnership with your doctors no matter what she says.

But also know that she is right about who actually must make most of the decisions.

Musings of a Dinosaur

“Patient empowerment, shared decision making, patients as partners in their health care; these are the latest buzzwords in this age of consumerism, where patients have morphed into glorified shoppers. Under this alleged new paradigm, it is our idealized job as doctors to explain everything to the patient (after properly diagnosing them, which of course includes explaining everything about each diagnostic test or procedure, including all the possible diagnoses we are thinking about) so that the patient can then make an “informed decision” about treatment.

“The dirty little secret is that medicine doesn’t work like that.

“Despite the abundance of information on the internet, the practice of medicine is more than just the application of an abundance of information. Above and beyond the knowledge conveyed during medical school (half of which is wrong, although no one knows which half) and the experience gained during residency training is the years of day-to-day exposure to that medical knowledge and training experience in real live people — the practice of medicine.

“This is why no amount of information — whether obtained from me, the internet, or even those really cool collections of pieces of dead trees called “books” — will ever properly equip a patient to make an actual medical decision. The dirty little secret is that in the final analysis, it will always be doctors who ultimately make decisions about medical treatment.”

Source: Blog, Musings of a Dinosaur, September 1, 2009