“The oddity of physicians’ insistence that patients follow doctors’ orders”

By the fourth sentence of the preface to The Silent World of Doctor and Patient, Jay Katz has quietly issued a startling challenge to a fundamental principle of the doctor-patient relationship. He writes:

It took time before I appreciated fully the oddity of physicians’ insistence that patients follow doctors’ orders. During my socialization as a physician I had been taught to accept the idea of doctors’ Aesculapian authority over patients. When I began to doubt this authority, that was the moment when the book began to take shape in my mind.

“The oddity of physicians’ insistence that patients follow doctors’ orders” – the phrase brings you to an abrupt halt. Jay Katz, who wrote those words in his landmark book published nearly a quarter of a century ago, died in late November at the age of 86.

--Michael Millenson at the Health Affairs Blog. Times obituary of Jay Katz here.

The Thirty-six Million Dollar Rectal Exam

In 2004, while working at a construction site, Brian Persaud was hit in the head by a large wooden plank, lost consciousness, and was taken to the emergency room at New York Presbyterian Hospital. There he received what he says was an unjustified digital rectal exam. Persaud brought suit against the hospital, and soon, four years later, the case will come to trial in the New York State Supreme Court. The arguments in the case are legal, but the underlying issues are also medical and ethical.

More at Clinical Correlations, the NYU Internal Medicine blog. (Thanks to D.M. Esq. for a quick legal education.)

Informed consent
Notes for a talk

Mr. C. is a 55-year-old Spanish speaking man with abdominal pain that has migrated from the epigastrium to the right lower quadrant of the abdomen. You are asked to “consent” him for a CT scan of the abdomen. Your Spanish is good enough to talk to him, but Mr. C. does not ask any questions, even when you repeatedly press him on the matter. He keeps saying, “Whatever you say, doctor.”

More here.