Patients need doctors to advise them on health care decisions

"Sick people need to be able to rely on their doctors not just for an expert recital of choices" when it comes to medical treatment, "but also for advice about what to do, and doctors should accept responsibility for the outcome," Marcia Angell, a senior lecturer at Harvard Medical School and guest columnist for the Boston Globe, writes in an opinion piece.

Over the past decade, doctors "have become vendors and patients consumers operating in a medical marketplace," Angell writes.

According to Angell, the system "is reinforced by various 'consumer-directed' health system reforms that place more of the financial burden on individuals."

While previously, "doctors made the decisions" and patients were expected to follow "doctor's orders," patients now are expected to be responsible for their health care decisions, "sometimes with little or no direction from their doctors," Angell says.

Doctors present the pros and cons of different treatment options, "but they're not supposed to decide which is best for the patient," she writes.

In addition, doctors countered some patients' suspicions that they might recommend a certain course of care because of a financial stake in the treatment by being "non-directive," Angell says.

However, she says that when patients have to take responsibility for their medical decisions, "they often feel abandoned and anxious" and "[i]f the choice turns out badly, they may face self-recrimination as well as worsened disease."

Angell says, "When you are seriously ill, you need a doctor, not a vendor."

She concludes, "Doctors owe it to you to tell you what they think you should do" (Angell, Boston Globe, 3/5).