The Australian medical community was struck last week by this court decision:
It appears that the patient, Luis, was attending the GP, Dr V, for 14 years from 1997 to 2011, and in that time Dr V failed to adequately address Luis’ obesity. Apparently the doctor mentioned gastric band surgery as a management strategy but did not attempt to convince Luis with adequate force that the surgery was the way to go. Apparently there was an inadequate effort to get Luis to diet.
This has ramifications, potentially, for any doctor treating anyone with a chronic but arguably self-imposed illness. The questions being raised are: when does the patient bear responsibility or his or her own actions regarding health and disease? To what extent must a doctor persuade as opposed to inform a patient about their management plan? If the doctor must persuade, where does that leave our views regarding medical paternalism and patient autonomy?
Looking at the case a little closer, I think there’s more to the story that this. For starters, Dr V is not an average GP. A quick Google reveals he practises nutritional medicine, administering intravenous vitamins and chelation therapy. Now, this is an area with which I have some familiarity, having done some work in this field in the 90s, and having attended courses through the Australian College of Nutritional and Environmental Medicine, of which Dr V is a Fellow. So I can’t help but wonder about the extent to which Dr V was treating Luis’ obesity by these alternative means.
Luis, on the other hand, is no fool. He is “a Colombian-born former left-wing revolutionary and one-time candidate for State Parliament”. He is a university graduate – how could he have been unaware that morbid obesity is unhealthy? How could he have been unaware that gastric band surgery existed as a treatment modality? How could he have not ever considered this option for himself?
I suspect the relationship between Luis and Dt V has been long and complex, and yet there has been a substantial communication breakdown between the two. I can’t help but think much more to this story will arise.
Achieving a balance between informing a patient and convincing a patient about a particular treatment strategy is often fraught, yet the essential principle is simple: treat the patient as you would want to be treated yourself. If that is too much of a leap, then treat the patient as you would treat a family member. This will require information at times and persuasion at other times. This will require offering the patient the benefit of one’s whole knowledge of all the treatments and services available in the field, not just those offered by one’s own practice. This means early referral when external services offer clear advantages.
I like to think that we do our best to achieve this balance at Peach.
I also like my patients to know that I am always happy to try to address any health concerns they may have outside of the specific sphere of cosmetic medicine.
And if I were a patient at Peach, I’d be happier knowing that the doctor here welcomes the chance to help with GP-type problems, and will refer whenever necessary to get me the best outcome for my skin or other health issues.