PATIENT CARE
This issue is initiated with the establishment
of a personal relationship between the
physician and patient. The effectiveness of
therapeutic measures prescribed is enhanced
in the presence of a sense of confidence and
trust. Reassurance by the physician under
these conditions may be all that is necessary to
improve the patient's well-being.
Similarly, for illnesses that are not easily
treatable, a sense by the patient that the physi-
cian is doing everything possible is an
essential therapeutic approach.
Clinical decision making should involve the
patient, especially where quality of life
issues are concerned. In such cases, a
determination of what the patient values most
should be made after lengthy conversation
between physician and patient. When it is not
medically possible to eliminate the disease and
its consequences, improving the quality
of life should of course be the treatment
goal.
ASSESSING TREATMENT
Objective standards are usually used in judging
the effectiveness of treatment. The
patient measures the outcome in terms of relief
of pain and preservation of or regaining
lost function. Although subjective, a patient's
state of health can be divided into a num-
ber of components: bodily comfort; physical,
social, professional, and personal activi-
ties; sexual and cognitive functions; sleep;
overall view of one's health; and general
sense of well-being. Relative to these
components, the patients' views of their disabili-
ties can be obtained by verbal exchanges.
Proper medical practice requires the consider-
ation of both the objective and subjective
aspects of treatment outcome.
Drug Therapy
New drugs are introduced every year. While it
is hoped that they are significantly better
than their predecessors, many have only a
marginal advantage. With this in mind, a cau-
tious approach should be used in dealing with a
new medication, unless it is established
with certainty to be a real advance. Otherwise,
it is preferable to continue to use estab-
lished drugs whose benefits and side-effects
are known to the treating physician.
Over the next few decades, the practice of
medicine will be greatly influenced by
the health care needs of the elderly. It is
estimated that the number of individuals over
65 will triple in the next 30 years. For this
reason it is important for the physician to be
familiar with the different responses of the
elderly patient to disease. The physician
must also be knowledgeable about common
disorders that occur with aging and altered
response of the elderly patient to
medication.
Iatrogenic Disorders
These disorders refer to those generated by a
testing or treatment modality and are not
connected to the existing medical
condition.
The judicious use of powerful medical tools
requires that the physician consider
their action, potential dangers, and costs.
Every medical procedure carries certain risks;
however, to benefit from the advances of modern
medicine, reasonable risks need to be
taken. Reasonable means considering both
positive and negative aspects of a procedure
and determining what is more desirable under
the circumstances. Special attention must
be given to the use of medications, which in
some instances can generate more harm
than good.
The physician's use of language and behavior
can at times lead to needless anxiety
if the patient is given a misleading impression
of his or her condition. Being involved
with treating the disease should not shift the
physician's concern from the overall well-
being and economic welfare of the
patient.
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