The Orthopedic Posterous

Very thoughtful. You've framed this from the doctor POV, and I give you a lot of credit for getting this far. ...but that's at most 1/2 way "there".

The answer to providing the "optimal" amount of info must START from the patient POV...and as you note the answer will vary from patient to patient.

Over time, I hope doctors will look at the task of defining "optimal" info for an individual patient as practicinig good science, not guesswork on their part.

Vince... thank you for your thoughtful comment. You are absolutely correct. Unfortunately this is not how most physicians are *taught* to communicate with patients. You may enjoy this post as well... much along the same lines of thought.
http://hjluks.posterous.com/patient-centric-care-and-the-personality-of-a

The objective of professional physician-patient interaction is treatment of the patient.

Therefore, patient's responsibility is to give any and all information/knowledge about his condition to the physician to receive best treatment. Armed with this information and observation of patient condition, the physician creates a treatment plan. This plan is to communicated to the patient with the caveat that
the the quality and content of instructions must be limited by the patient's capacity and interest.

As an informed patient, I want to utilize all the communication tools to receive comprehensive and timely treatment from the physician. Hopefully, my physician will have the incentive and time to communicate with me via email, twitter, video chat. This is one patient's Point of View (POV) which may not be true of all patients as you have mentioned in your article.

Thank you for your comments....

Sent from my Verizon Wireless BlackBerry

Excellent summary, Dr. Luks...
I deal with these issues in my practice on a daily basis. My personality is actually well-suited for the patient who wants to know "everything". I am most uncomfortable with the patient who just says "Whatever you think is best, doc".

Earlier this year I found myself in a place where *I* needed surgery and was seeing a professional colleague that I have worked with for years. Strangely enough I found myself playing the role of the latter ("Whatever you think is best, doc") patient. Interesting.

The challenge to physicians is our fear that differential counseling will open us up to criticism and liability. (ie is it right to give more information to the obsessive evidence seeking patient while giving less informatin to a patient like... well, ... me!)

C.O. It truly is a dilemma. Many of us have had patients in our offices who are facing surgery, and do not want to know anything about it... others want to know everything. Last week I had someone ask what brand sutures I was going to use !!!!!

I like your term *differential counseling*. I've seen too many patients suffer from analysis paralysis following my efforts to offer them numerous choices... and I've not been comfortable operating on patients who insist that we do not need to discuss *this* further. This is a very interesting area for the health care social media crowd to address... e

What a fantastic graphic - such a complex issue so elegantly described. Although, in a world of information overload, it's not surprising that most people don't have the time/patience/literacy to dig into the thicket of often contradictory medical information.

I try to help friends and family prepare for the "big" visits - usually to specialists - by making a one-pager of their existing diagnoses, treatment plans, prescriptions and supplements, symptoms, family histories, etc. to organize their information and show to the doctor if they're interested. I also separately lay out the potential treatment plans - mostly so they are familiar with the medical terms before they go into the visit.

I often wonder what information doctors really want from patients. Many more patients would arrive prepared if they knew what doctors were looking for. It seems to be all over the map.

Deidre... Phenomenal comment... and that is exactly the reason I posted this a few months back...
http://hjluks.posterous.com/new-patients-are-you-prepared-for-your-visit

Dr. Luks> If a 'prepared' patient creates a win-win situation, then what are the reasons that the type of questionnaire forms you have on your website, are not popular with other physicians?

On a similar point, you have graciously stated that you do not expect reimbursement for email communication with the patients because office efficiency more than compensates for your time. Then, what are the hurdles to propagate this channel to other clinics?

Thanks in advance!

Sushil... perhaps we should talk?