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Patients at the centre: in our practice, and in our use of language
  1. David S Goldfarb, M.D.1
  1. 1New York Harbor VA Medical Center
 NYU School of Medicine
 New York, USA

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    Dear editors,

    In their editorial about patients sharing decision making responsibilities with physicians, Guyatt et al1 review some of the evidence that patients favour involvement in their own care. They neglect a more complex body of evidence, however, that suggests that while patients like the idea of greater choice, they often find it to be less satisfying in practice.2 Just as the authors suggest that physicians incorrectly “assume that physiological outcomes will lead to improvements in mortality and quality of life,” they themselves assume that more choice will lead to greater patient satisfaction.

    As suggested by Barry Schwartz, a psychologist at Swarthmore College, the opposite may be true.3 Schwartz has identified a number of problems that arise as choices proliferate.4,5 Firstly, reliable information is difficult to obtain. The advent of the internet has increased access to information, as Guyatt et al contend, but this access may be to as much unreliable as trustworthy information. Obtaining to additional opinions and performing research are potentially costly and time consuming.

    Another problem is that as options multiply, patients’ standards for what is an acceptable outcome mount, with a loss of perspective of what may reasonably be achieved. Schwartz also notes that people may fear making the wrong choice and allow that fear to guide their choices. Or, post hoc, they may come to believe …

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