Example of a disagreement between patient and physician
delirium
STILL, ALCOHOL WITHDRAWAL
Chief physician: We know that you normally take Diazepam, which has a long half-life…Patient: Yes, 24 hours.Chief physician: Even longer, especially if the liver is not working properly. I've seen two people die from Diazepam. We prefer to prescribe Lorazepam.Patient: I do not tolerate Lorazepam.Chief physician: What do you mean by “don’t tolerate”?Patient: Once when I withdrew from alcohol and doctors gave me Lorazepam I hallucinated. I saw a mouse in my room. Then I had delirium and woke up in another hospital.Chief physician: We cannot assume that this was because of the Lorazepam. It was more likely due to alcohol withdrawal.Patient: Yes, but I’ve never experienced anything like that with Diazepam.Chief physician: It is important to me that we informed you about this…A recent study showed that patients with active decisional preference are less satisfied with their care and have less trust in the healthcare team compared with patients preferring less in depth involvement in medical decisions.This trial has several limitations. First, we only included Swiss teaching hospitals. This might cause a selection bias and limits generalisability of the findings. Second, using a pragmatic approach, ward rounds in the three participating hospitals were not standardised regarding clinical practice and to ensure external validity. Consequently, the internal validity might be reduced. Third, the questionnaire used to assess patient perception has not yet been validated. Finally, there is no well accepted definition of sensitive topics and we thus defined it based on the clinical experience of the physician–researcher team. Still, there is some data suggesting that patients find value and comfort when their doctors openly discuss uncertainty with them.