Doctor’s Orders & Self-Determination In Healthcare


Blog post by Joe Babaian

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.

~ William Osler

We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.”

~ Atul Gawande

With these quotes, we know right away that the art of medicine was and continues to be understood by those who take time to think about the bigger picture! Two greats and many more unnamed past and present keep us working to be the best we all can be in healthcare for the right reasons.

Doctor’s orders – sounds simple, and each of us has a conditioned reaction to the phrase. We know it’s a call to listen, to follow instructions, to trust, to be taken care of. It’s not about dollars or insurance, it’s about the final link in the healthcare chain at the point of personal contact. Care at the N of 1 – but do we follow (blindly or otherwise with true collaboration) these instructions from our clinicians or do we push back? And if we do push back, how can we be sure we are making the best choices?

There are myriad diagnoses and at least twice as many courses of action to follow. This past week on Twitter I was part of an important public health conversation promoted by Maram Museitif @MaramMPH:

Today’s chat isn’t about vaccines but it IS about medical advice/directives and the patient right to self-determination. Maram’s questions prompted a long list of thoughtful and useful followups from several in the #hcldr community. Check out her Tweet and the branching threads for a great read.

The point here is easily taken. When the clinician and/or healthcare staff is messaging to patients the “Doctor’s Orders”, suggestion, hope, or wish to administer the HPV vaccine for the purpose of preventing cancer, the patient (or their family) is faced with the decision of self-determination. Do we accept that our well being is being thought of by an expert tradition of healthcare, discuss and receive more detail and education, doubt and ask for proof, decline, or defer? This is the essence of free will. I use the HPV vaccine as the example since the vast majority of the U.S. doesn’t mandate the jab at this time. So for now, this is a personal choice.

I won’t give you the answer since there isn’t one. Healthcare decisions, for the most part, are up to the patient. Let’s think a little deeper, put aside bias and soapboxes, and discuss when, how, and where we should or should not be following “Doctor’s Orders” and how the modern milieu has changed our behaviors for good or bad.

Please join me this week as we host the  #hcldr tweetchat and dive into personal choice and consider all the implications. Be part of the conversation on Tuesday June 26th at 8:30pm ET (for your local time click here) when we will be discussing:

  • T1 We all want to make the best choices for our own healthcare. In what ways should we accept, evaluate, or reject “Doctor’s Orders”?
  • T2 How does our connected society help or hinder our decision-making for healthcare?
  • T3 What approach should clinicians and staff be using when making clear recommendations/directives for our well being? AKA avoiding paralysis by analysis.
  • T4 Going forward, how will technology help support making the best decisions for our healthcare and should we again learn to follow “Doctor’s Orders”?


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