I would agree that the patient preference piece is
HARD to sort out. And, it's easy enough to list
illiteracy, differing values, different language (and
perhaps other issues) as parts of the barrier to
understanding patiet preference. BUT, in each real
life, case-by-case situation, how easy is it really to
understand which (ones) of these are operative.
In clinical practice, how often to we have the time
and patience to fully sort out whether someone's lack
of understanding is due to language or intelligence or
comprehension? Or how about sorting out whether a
patient's seemingly poor choice is due to different
values from mine, or a communication barrier, or lack
of information or lack of intelligence?
There is quite a body of literature out there on
"reflective" practice, and I think there could be some
fertile ground for studying how insights from that
work can inform the clinical practice of EBM.
Bill Cayley MD
--- Diana Rodríguez Hurtado <[log in to unmask]>
wrote:
> Dear Colleagues:
> About EBM, I am defender of EBM, but in the topic
> about Patient values and preferences in order to
> involve the patients in the decision making process,
> I have a commentary :
> Don´t you think that sometimes you can find barriers
> for example in developing countries? Example, when
> you are in front a patient who is analphabet or that
> belong to ethnic group whose lexicon we don´t know,
> with the risk that the patient take an erroneous
> decision by ignorance.
> Some day I had listened:
> "A man who is not informed, he can not have opinion,
> and a man who has not opinion, he can not take
> decision" .
> I would like to receive your answers.
> Sincerely.
>
> Diana Rodriguez M.D.
> Associate Professor Faculty of Medicine "Universidad
> Peruana Cayetano Heredia".
> Master in Clinical Epidemiology.
> Member of INCLEN (International Clinical
> Epidemiology Network).
> Lima , PERU.
> e-mail [log in to unmask]
>
> [log in to unmask]
>
>
Bill Cayley, Jr, MD MDiv [log in to unmask]
Augusta Family Medicine Home Address
207 W Lincoln 3433 McIvor St
Augusta, WI 54722 Eau Claire, WI 54701
Work: 715-286-2270 Home: 715-830-0932
Page: 715-838-7940 Cell: 715-828-4636
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