The BMJ Today: Unravelling the notion of informed patient choice

“Doctor, what would you do in my shoes?” This simple plea for advice from a patient may stump many a doctor.

Involving patients in decisions about their care is increasingly regarded as the sine qua non of medical practice. Anna Mead Robson cautions, however, “that by continuing to champion patient choice at the expense of ‘old fashioned’ paternalism we risk depriving some patients of the advice and relief they are seeking.”

Drawing on her days as a patient, she writes of times when she longed for decisions to be made on her behalf. Indeed, if information about treatment options is all a patient wanted, Dr Google would have provided a cheaper and more exhaustive consultation, suggests Robson.

Gerd Gigerenzer explores the other side of the equation in an observations column. Doctors, he says, often avoid making explicit recommendations. Instead they frame information to lead patients in one direction or another, based on their intuition or preference.

Take the scenario of a patient having to undergo potentially lethal surgery. Gigerenzer suggests that one is more likely to opt for the surgery if the doctor says that 90% of patients are still alive (survival frame) five years after surgery, rather than saying 10% of patients are dead (mortality frame). Although both essentially mean the same thing, and none communicates the chances of survival without surgery altogether, the way information is presented can influence patient choice.

Alongside appreciating these subtleties of risk communication, it is important to step back and examine what drives this information. Clinical recommendations and guidelines often risk distortion being promulgated by experts with financial ties to industry. At The BMJ, we are phasing in a new policy to foster independent and unbiased coverage of clinical topics. Starting from next year, we will only pursue clinical education articles written by experts with no financial ties to industry. We hope this move will enhance our readers’ trust in the journal’s content, and are eager to hear your views.

Anita Jain is India editor, The BMJ.