Why does the Patient know best?

macawake, MSN · May 18, 2015

Is anyone aware of any research that supports our current practice paradigm. Of course, in order to be as difficult as possible, I am looking for "good" studies. Not weak self-serving apriori studies.

Could you perhaps give an example of research that you consider "weak self-serving a priori".. I'm having some trouble figuring out what you mean here, especially considering that the topic is "the patient knows his/her body best". Also, what's your definition of a "good" study when it comes to how a person experiences her/his body?

I'd also welcome some clarification regarding what aspects of "knowing one's body" you're interested in researching. I have a nagging suspicion that this might be about pain and a person's perception of it and how they report it. I might be wrong, so please elaborate.

So for many years now I have accepted the indoctrinated information from nursing school that, "the patient knows his/her body best."

I could understand your scepticism if the claim was that "patients always know and do what's best for them", but who on earth do you suppose knows a person's body better than the individual actually "residing" in it?

A nurse might know a patient's body better than the patient in the sense that they have an exact number for the patient's serum potassium after checking the lab results, but how it feels to be in the body is the patient's area of expertise. I don't think that really needs to be proven through research.

allnurses Guide · May 19, 2015

This really feels like a homework question. Part of the BSN process is doing your own research. If you are going to a decent school you should have access to a god on-line library with data bases specifically geared towards nursing research and journals. I spent two weeks researching my last paper all while working 5 days a week and raising a family.

That being said I don't have any evidenced based research to cite but it has been my experience in the last 12 years as an ADN that when the patient is encouraged to be a full partner in his/her care the outcome is often better than when they are kept in the dark or not listened to with regard to their preferences.

I am not trying to be mean but there are a lot of students on this site who are doing their own homework. Plus I was told I needed to be a bit Crusty to become a proud member of the Crusty Old Bat Society.

Hppy

MatrixRn · May 19, 2015

I am not that there will be evidence based studies describing what you ask. We are all familiar with the indoctrination that comes from attending nursing school. And let's be clear, no matter the profession there is some indoctrination going on.

For nursing yes, there is the ""philosophy"" that the patient knows best and this is used most often in relation to pain.

I can agree that if I am talking to someone in relation to pain they will know where their pain is, how much pain, when is started etc.

That said, we take that information and apply our nursing knowledge base.

So many people have the misguided idea that post surgery they should be absolutely pain free....and that is just not the case. I doubt there is a nurse out there who would run to the PIXIS for an IM of Morphine based on just what the patient said....nope they are assessing as they are listening, so the proper level of care can be applied.

As to the 'healthcare is a right', I honestly do not remember that from nursing school. I am guessing 'a right' means a standing granted by legal status.

That said, based on the constitution, we have a right to free speech, the right to privacy, the right to bear arms and the right not to have to soldiers come and live at your house during war but I do not see access to healthcare listed.

The activation of the ACA required insurance for all, so that might make it a 'right'?.

kbrn2002, ADN, RN · May 25, 2015

I'm not sure that you will find studies that support what you are looking for. Of course the patient knows their own body best, but most of the ways they communicate this knowledge to their health care providers is subjective. It is then up to the health care team to evaluate and treat based both on their own objective findings and the patients subjective findings.

This in no way translates to the patient knows best. The patient does not have the education to interpret the combination of objective and subjective to formulate the best plan of care. Even after the best plan of care is determined the patient does not always follow it. Noncompliance is certainly nothing new. This directly contradicts the statement that the patient knows best. For example, a diabetic that refuses to follow their plan of care and suffers serious consequences for this noncompliance can say all day that they know how they feel but the end result proves that they did not indeed know best.

Fiona59 · May 26, 2015

Healthcare is a right in nations that have universal healthcare.

Me thinks the OP is either Canadian, Australian, or a very fluent English speaking European.

Always love these types of first post essays.

vanilla bean · May 26, 2015

If you are going to a decent school you should have access to a god on-line

Aw man, I knew I didn't go to a top-tier school, but we didn't have anything even remotely resembling access to an online god.

amoLucia · May 26, 2015

Aw man, I knew I didn't go to a top-tier school, but we didn't have anything even remotely resembling access to an online god.

Amen!

allnurses Guide · May 26, 2015

Aw man, I knew I didn't go to a top-tier school, but we didn't have anything even remotely resembling access to an online god.

Sorry I have a sticky keyboard :)

Hppy

toomuchbaloney · May 28, 2015

OP has not returned.

Too bad.

I was wondering who he/she believed might "know" the body of a person better than said person his/herself?

The premise of the thread seems a bit arrogant to me.

banterings · Jun 10, 2015

First let me address sources. The best source for free resources and the defacto industry standard is the National Library of Medicine (NLM) maintained by the US Government's Department of Health and Human Services' (HHS) National Institutes of Health (NIH).

Begun as a one-room Laboratory of Hygiene in 1887, the National Institutes of Health (NIH) today is one of the world's foremost medical research centers. An agency of the Department of Health and Human Services, the NIH is the Federal focal point for health research.
NIH is the steward of medical and behavioral research for the Nation. Its mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. (Source: National Institutes of Health)

You can see where the NIH fits in to the HHS Organizational Chart here: NIH collaborates with other agencies and divisions of the Department of Health and Human Services (HHS). As is often attributed to the philosopher and physician Aristotle (circa 300 B.C.), the whole is greater than the sum of its parts. For an organization as complex as HHS, which has many operating divisions and staff divisions, synergy between the different components of the Department is vital to the success of the whole. Recognizing this, Congress added section 403A(a) of the Public Health Service Act, 42 U.S.C. Â§ 283a(a), Annual Reporting to Increase Interagency Collaboration and Coordination, via Section 104 of the National Institutes of Health Reform Act of 2006. This law mandates that the NIH Director provide to the Secretary of HHS an annual report on NIH's collaborations with other HHS agencies.

NIH maintains the The National Library of Medicine

The National Library of Medicine (NLM), on the campus of the National Institutes of Health in Bethesda, Maryland, has been a center of information innovation since its founding in 1836. The world's largest biomedical library, NLM maintains and makes available a vast print collection and produces electronic information resources on a wide range of topics that are searched billions of times each year by millions of people around the globe. It also supports and conducts research, development, and training in biomedical informatics and health information technology. In addition, the Library coordinates a 6,000-member National Network of Libraries of Medicine that promotes and provides access to health information in communities across the United States. (Source: National Library of Medicine)

Next, there are 2 distinct issues that arise here, that is ethics and science. Despite what science deems the best course of treatment, human rights and personal autonomy make the ethical issue override the science. What the OP describes is "physician paternalism vs patient autonomy (AKA informed consent)."

Note: I am not going to get in to all the nuances, but generally an attending physician diagnoses and prescribes the course of treatment. Nurses deliver the course of treatment. Again, there are NPs, different states have different allowances/restrictions on nurses, and so on. I am just going to group healthcare providers on one side and patients on the other to address the issue of "who knows best."

Even nurses have options to deliver the COT, such as the site for an intramuscular (IM) injection. There are 4 main sites that can be used for IM injections. Thigh (vastus lateralis muscle), Top of upper arm (deltoid muscle), Hip (ventrogluteal or gluteus medius muscle), and Buttocks (dorsogluteal muscle). The nurse may choose one site and the patient another.

In 1847, the inaugural Code of Ethics of the American Medical Association (AMA) stated:

The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them.â€ (Source: American Medical Association. Code of Ethics. 1847:chap I, article II, Â§6.)

The ethical implications have changed. The AMA Principles of Medical Ethics in 1980 stated that

A physician shall respect the rights of patients. . . .â€ (Source: American Medical Association. Principles of Medical Ethics. 1980:Preamble, Â§4.)

As to the ethics of consent, look at the case of a 69-year-old Caucasian man who refused urgently indicated medical intervention (same day bypass surgery) because of severe tomophobia. (Source: Tomophobia, the phobic fear caused by an invasive medical procedure - an emerging anxiety disorder: a case report)

You have to remember, you can evaluate the medical/surgical/statistical risk of doing vs not doing a procedure, but you can't evaluate what the damages would be to the patient's mental health or bodily integrity.

Violations of one's bodily integrity can have severe side effects such as PTSD. As Goffman noted, lacking control over others' access to one's body leaves individuals feeling threatened and out of control, as though the stigmatized individual is a person who can be approached by strangers at willâ€ (Source: Goffman, 1990. Stigma.)

Here is a good British university paper (with very good citations): "Paternalism in Medical Ethics: A Critique," by the Journal of The University of York Philosophy Society. It points out:

Paternalism is problematic because the definition of a patient's best interests used by a paternalistic approach is too narrow, because â€˜uch best interests are not determined by the medical facts alone' (Hope et al 2008 P.61); the patient's views and beliefs matter too.

The question of "who knows best scientifically/medically" is irrelevant because the ethics of the human rights issue of autonomy overrides it. The simple answer is the patient has the right to choose.

Emergent, RN · Jun 10, 2015

What I want to know is how do you pronounce paradigm, and does anyone use that word in real life?