With increasing advancement in medical care comes the ethical dilemma of how much treatment is too much and for whom? This issue is particularly consequential for the elderly, the greatest consumers of healthcare. When determining the appropriate level of medical intervention for older patients several issues, that at times conflict with one another, come into play: the need to ration limited medical resources, the desires of the patient, the capacity of an older patient’s body to withstand different types of treatment, the patient’s quality of life and the desires of family members involved in medical care decision making. Establishing patient-physician trust in this context can prove challenging.
Ubachs-Moust et al. (2010) provide compelling evidence about the level of physician trust key professionals in the Dutch medical industry afford doctors working with the elderly. The study suggests that within the Dutch system of socialized medicine, non-physician medical professionals (e.g. hospital administrators, patient advocates, healthcare economists, etc.) afford the most trust to doctors who consider a patient’s age only with regards to how well their bodies can handle treatment. These respondents think that the cost of medical interventions should not be a primary factor in determining the level of medical treatment for the elderly.
I value the discussion on physician-patient trust, from the perspective of medical professionals. Nonetheless, I wanted to hear more about the voices of elderly consumers of medical services and their views on what elements influence doctor-patient trust. Ubachs-Moust et al. (2010) do not reference such research. This makes me wonder whether investigators have explored elderly patient narratives surrounding doctor-patient trust. From a consumer perspective the client’s opinion regarding the elements necessary to establish trust in a medical relationship would be the most important one of all.
Ubachs-Moust J, Houtepen R, Van der Weijden T, ter Meulen R, & Vos R (2010). Trust in medical decision-making concerning older people: the views of key professionals in the Dutch health care practice. Health (London, England : 1997), 14 (6), 564-84 PMID: 20974692
That’s an interesting question. I’m actually not familiar with such research, but I note that my own mother was rather distrustful of her PCP because she felt he was overagressive in treating. She found another doctor who is more conservative, who pruned her prescription list and told her not to worry about stuff, and she’s much happier with him.
We don’t do enough qualitative research to understand patient perceptions of physicians. There are closed-ended surveys, but they don’t tell us much in my opinion. Maybe I’ll write a proposal . . .
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The general meaning of ethics: rational, optimal (regarded as the best solution of the given options) and appropriate decision brought on the basis of common sense. This does not exclude the possibility of destruction if it is necessary and if it does not take place as the result of intentional malice.:’
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