96% say only the attending physician should be making clinical decisions regarding the patient

Do you agree or disagree with the following statement:

When physicians prescribe a particular medication, they evaluate which drug is likely to work best for the individual patient — based on their knowledge of the patient’s illness and treatment history, other medical conditions, drug-to-drug interactions, and drug-disease interactions. Only the prescribing physician has enough clinical information to make these decisions.

When this question was asked in the survey that I conducted with physicians, physician organizations, and patient advocates from all across the US, 96% responded that only the attending physician should be making clinical decisions regarding the patient.

Now if you ask me, there is only one person I’d want making clinical decisions about me the patient — my doctor. So, it’s not surprising that 96% agreed that decision should only be made by the attending physician.

What is surprising is that 4% said someone else should be making that clinical decision.  Perhaps the 4% were doctors and were making their own clinical decisions? Or perhaps some were thinking of other people they might ask help them decide on treatment options presented by their attending physician. For me, of course, I’d also want my wife, family, and friends to give me their opinion about really important (i.e. difficult) decisions that I might have to make. But, these people are helping me to weigh options — options that are being presented by my doctor.

However, the context of the survey was about therapeutic substitution. In other words, is it ok for someone other than the attending physician — such as your health insurer, pharmacist, or the pharmacy benefit manager dispensing your prescribed drug — to give you a different drug than what your physician prescribed.

Who do you want making clinical decisions about you? Please vote below and tell me what you think — do you agree with these 96%?

7 Responses to “96% say only the attending physician should be making clinical decisions regarding the patient”
  1. As an overall statement I would agree that only the attending physician should make clinical decisions regarding a patient. But there are many layers to this decision making process. As a surgeon in the UK I work as part of a team who are responsible, as a whole, for our patients. Individual members of that team can make clinical decisions based on their level of experience and expertise. However, the overall care plan for the patient is determined by the Consultant Surgeon (“Attending” in the US). I would not over-rule a decision made by the attending physician without a VERY good reason.

    That having been said, the care-plans are put in place with the patient involved throughout. There’s no point operating on someone who has expressed that they are against it for whatever reason. In this situation the decision is made by the patient.

    In terms of prescribing medication etc. the decision is made by the attending physician on what medication to use and no other healthcare professional should be involved in that decision unless he/she is adequately trained and has sufficient experience.

    Health insurers, Nurses, Pharmacists etc. should not be altering medication already prescribed by a trained and experienced physician.

    • Michael Wong says:

      @dialdoctors comments:
      “In the context of the survey yes. Doctors probably agree because they have to pick up the pieces if something goes wrong”

    • Michael Wong says:

      @thenursesnurse reminds us that other HCPs working around the attending doctor cannot just be robots and follow orders without thinking about what is best for the patient with her comment: “Any RN who follows an order without question is not doing their job.”

      However, as @thenursesnurse had commented earlier “Need to follow the chain of command & go back to the MD and report the switch”

  2. Ben Garrettt says:

    It’s interesting that your instant poll runs in a very different direction!

  3. Working as a surgical nurse, where there are often multiple physicians consulted, this is a tricky subject. The surgeons may order a medication but the hospitalist may decide that something else would be better suited.

    Also, as a rule our pharmacy substitutes for almost everything. There is only a very small list of drugs that our pharmacy actually carries. As a patient, if you want to take nexium, you have to bring it from home, because otherwise you are going to get omeprazole.

    But I do feel that patients have a right to be involved in their healthcare and assist in making informed decisions about the medications that they are prescribed. I personally do not take well to being told to take something without being given options and asked my opinion on the matter. Just writing down a script on a pad and telling me that it will work is not good enough. Tell me about this drug, what my other options are, if there are generics and any other information that may be pertinent. The patients need to be involved in the process. This helps ensure greater success in adherence and understanding of their overall healthcare.

    But that’s just the humble opinion of this nerdy nurse.

  4. I disagree. Physicians should be the primary conduit for information, but they can’t know everything. Here’s my five reasons why this isn’t a rational strategy in today’s world – http://georgevanantwerp.com/2011/04/06/the-physician-as-island-versus-support-from-intermediaries/.

  5. Michael Wong says:

    Fur further thoughts on the need for a substitution process, please see http://wp.me/p1fYJ7-j4

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