How much physician guidance do patients want with medical decisions?

As access to medical information has become more common, patients are gaining empowerment in their medical care.

And rightly so. Gone are the days where medical decisions are paternalistic in nature, with the physician leading, and the patient following. Today, an ideal medical decision has input from both patient and provider.

But, have we gone too far the other way?

In a recent New York Times column, Pauline Chen asks whether doctors are yielding too much decision making authority to patients.

She cites a study showing that too much physician restraint in medical decision making may not be what patients want, and, in fact, may be unethical:

Researchers interviewed more than 8,000 hospitalized patients at the University of Chicago. When it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consider their opinions. But a majority of patients — two out of three — also preferred that their doctors make the final decisions regarding their medical care.

Dr. Chen also says that the ideal medical decision should be shared in nature. Patients need to “be more explicit and ask for that help,” while doctors “will need to be more mindful of whether patients want them to share information, be directive or hand over the responsibility of the decision.”

There is a spectrum of how much physician involvement patients want. Some, like the most voracious e-patients, may want physicians to suggest and inform, but leave the ultimate decision to them. Others may prefer the old paternalistic approach, and let doctors have the final say.

The only way to know is through a continuous relationship with a single provider, so that comfort level can be developed over time. After several encounters, a clinician should have a sense of how much, or how little, direction a patient needs.

Sadly, as patients cycle through provider after provider in our increasingly fragmented health system, continuity of care is lost.

And that makes it more difficult to give patients the proper amount of guidance when making difficult medical choices.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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