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Doctor, What Would You Do?

Minkoff, Howard MD; Lyerly, Anne Drapkin MD, MA

doi: 10.1097/AOG.0b013e3181a11bbb
Current Commentary

Patients making difficult choices among therapeutic options often ask their physicians what they would do if they were in the same situation. When faced with that question, physicians might be concerned that a direct answer could infringe on a patient’s autonomy by substituting the physician’s unique worldview or experience for their patients’. However, refusing to answer the question might lead a patient to feel unsupported at a difficult time. In this article we describe an approach that allows a physician to contribute to the patient’s decision without inadvertently being coercive. That approach requires physicians to meaningfully shape therapeutic options, and assist patients in making difficult decisions. It is dependent on the physician being aware of the role of both their patients’ values, and health values (eg, autonomy, futility) in decision making. It also requires an awareness of the force of language, both stated and implied, in shaping a patient’s choice. To make a good decision, women need more than accurate information. They also need to be supported and sense empathy and understanding from their physicians and feel cared for. Although the facts (benefits and harms related to any given choice) are a necessary component of counseling, without discussion of values, they do not lead to a truly informed decision.

Counseling a patient who asks how you would manage your own care requires an understanding of respect for autonomy that goes beyond neutral counseling.

From the 1Department of Obstetrics and Gynecology at Maimonides Medical Center and The State University of New York Downstate, Brooklyn, New York; and 2Department of Obstetrics and Gynecology and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, North Carolina.

Corresponding author: Howard Minkoff, MD, Maimonides Medical Center, 967 48th Street, Brooklyn, NY 11219; e-mail: hminkoff@maimonidesmed.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.