Being Selective

Patients do not need to be involved in every healthcare decision. When decisions are low stake, and do not involve trade-offs (where patient preferences are important in deciding what is best), clinicians do not need to involve patients in the decisions. For example, patients suffering from chemotherapy-related nausea probably do not want a lengthy discussion of the merits of one class of medication versus another. Instead, they want relief from their nausea.

When deciding how much to involve patients in a decision, clinicians should think about whether reasonable clinicians could disagree about the course of action, not just clinicians from one's own specialty but also those from other specialties. The greater the medical consensus, the less need to talk at great length to patients about inferior alternatives.16

Clinicians should think about how quickly a decision needs to be made. In emergency situations, it is often diffi cult to involve patients in treatment decisions. Furthermore, if emotions are running high, patients are often most likely to rely on clinicians for advice. Patients still need and deserve information about their treatment alternatives, but when patients are too emotional to make decisions, they will often be happy to receive recommendations from their physician. When decisions are not so urgent, however, there is more opportunity to involve patients. Decisions in oncology span the spectrum from the emergent to the elective and clinicians should tailor their decision-making style to this spectrum.

A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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