Physicians that think a particular procedure is very important sometimes overstate the importance of the procedure, present few alternatives, or minimize the risk.
Conversely, physicians who think a procedure ill advised sometimes overstate the risk, minimize the benefit, or amplify the alternatives.
Neither of these strategies is recommended.
This is a sure way to lose the trust and confidence of your patients and to place yourself in a potentially problematic situation.
Yet, some degree of paternalism and guidance is often warranted, particularly when presenting a complex decision; in fact, most patients and families value direction when given in a clear manner by a trusted physician.
This is best done by presenting the facts in a form that is easily understood by patients, and by emphasizing the key issues, while including any others that are necessary to address.
For example, while death is a potential risk for many procedures, it is often a very rare complication.
For straightforward procedures, it is reasonable to let patients know that you are obliged to mention the more serious risks, but to de-emphasize those that are rare and anxiety producing.
Conversely, if the risk is high, it is necessary to let patients know this clearly.
Remember to consider the long-term consequences of the intervention, not just the risks and benefits of the procedure itself. An example here is gastrostomy (PEG) placement, where a number of undesirable consequences may emerge over the next several months.
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- Present reasons for a procedure and the potential risks involved in an honest, straightforward way.
- When the risk is low, explain that you are obligated to mention the possibility of dying from a procedure, but de-emphasize its likelihood. Conversely, if a procedure carries a high risk, be honest in discussing this.
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