Patient, Heal Thyself: How the ''New Medicine'' Puts the Patient in Charge

Robert Veatch is one of the founding fathers of contemporary bioethics. In Patient, Heal Thyself , he sheds light on a fundamental change sweeping through the American health care system, a change that puts the patient in charge of treatment to an unprecedented extent. The change is in how we think about medical decision-making. Whereas medicine's core idea was that medical decisions should be based on the hard facts of science—the province of the doctor—the "new medicine" contends that medical decisions impose value judgments. Since physicians are not trained to make value judgments, the pendulum has swung greatly toward the patient in making decisions about their treatment. Veatch shows how this is presently true only for value-loaded interventions (abortion, euthanasia, genetics) but is coming to be true for almost every routine procedure in medicine—everything from setting broken arms to choosing drugs for cholesterol. Veatch uses a range of fascinating examples to reveal how values underlie almost all medical procedures and to argue that this change is inevitable and a positive trend for patients. Doody Review Services Reviewer: Rebecca L Volpe, B.A.(Saint Louis University) Description: This book offers a unique opportunity to read the thoughts of a founding father of bioethics on where medicine has been, where it is now, and where it must go in the future. Robert M. Veatch argues for a "new medicine," which rejects the belief that physicians can ever know what is medically best for their patients based on medical science alone because every medical choice requires nonscientific value judgments. Purpose: His purpose is to describe the new medicine and the ethic in which it is grounded. He achieves this purpose by first laying the theoretical groundwork, and then applying the new medicine lens to a number of issues. One topic he examines is informed consent. He is critical of the current model of informed consent, arguing that "the model in which the clinician decides what he or she believes is best for the patient, pausing only to elicit the patient's concurrence (consent), will no longer be sufficient." His argument is careful and thorough, with many case studies and examples along the way. Audience: This book is a must-read for those engaged in healthcare delivery. Healthcare consumers, students, and other lay people will also likely find these arguments interesting, timely, and compelling. Features: Part I explores some typical cases that show how the new medicine requires thinking that is different from that of modern medicine, and presents an in-depth explanation of why the physician can no longer be presumed to know what is best for the patient. Part II introduces some new conceptions of old concepts and terms and applies the new medicine framework to an in-depth look at healthcare insurance, informed consent, hospice, and obesity. Part III looks at broader aspects of healthcare under the new medicine, including subject recruitment for research, clinical practice guidelines, and establishing medical "facts." Assessment: The author offers engaging and thoughtful ruminations about the current medical paradigm that include interesting inquiries into historical practices and beliefs. He applies his theoretical assessment of the new medicine to concrete topics such as informed consent and healthcare insurance, offering prescriptions for how these practices should change. The book is a compelling examination of how to catch medicine up with the times, and it is not to be missed. Contents......Page 14 List of Cases......Page 16 The New Medicine: An Introduction......Page 20 PART I: WHY DOCTOR DOES NOT KNOW BEST......Page 36 1. The Puzzling Case of the Broken Arm......Page 38 2. Hernias, Diets, and Drugs......Page 42 3. Why Physicians Cannot Know What Will Benefit Patients......Page 50 4. Sacrificing Patient Benefit to Protect Patient Rights......Page 60 5. Societal Interests and Duties to Others......Page 68 6. The New, Limited, Twenty-First-Century Role for Physicians as Patient Assistants......Page 74 7. Abandoning Modern Medical Concepts: Doctor’s “Orders” and Hospital “Discharge”......Page 82 8. Medicine Can’t “Indicate”: So Why Do We Talk That Way?......Page 88 9. “Treatments of Choice” and “Medical Necessity”: Who Is Fooling Whom?......Page 100 PART II: NEW CONCEPTS FOR THE NEW MEDICINE......Page 106 10. Abandoning Informed Consent......Page 108 11. Why Physicians Get It Wrong and the Alternatives to Consent: Patient Choice and Deep Value Pairing......Page 120 12. The End of Prescribing: Why Prescription Writing Is Irrational......Page 128 13. The Alternatives to Prescribing......Page 136 14. Are Fat People Overweight?......Page 152 15. Beyond Prettiness: Death, Disease, and Being Fat......Page 158 16. Universal but Varied Health Insurance: Only Separate Is Equal......Page 172 17. Health Insurance: The Case for Multiple Lists......Page 178 18. Why Hospice Care Should Not Be a Part of Ideal Health Care: I. The History of the Hospice......Page 192 19. Why Hospice Care Should Not Be a Part of Ideal Health Care: II. Hospice in a Postmodern Era......Page 200 PART III: THE NEW MEDICINE AND THE NEW MEDICAL SCIENCE......Page 210 20. Randomized Human Experimentation: The Modern Dilemma......Page 212 21. Randomized Human Experimentation: A Proposal for the New Medicine......Page 226 22. Clinical Practice Guidelines and Why They Are Wrong......Page 236 23. Outcomes Research and How Values Sneak into Finding of Fact......Page 246 24. The Consensus of Medical Experts and Why It Is Wrong So Often......Page 256 Epilogue: A Patient Manifesto......Page 270 Notes......Page 276 A......Page 294 C......Page 295 E......Page 297 H......Page 298 J......Page 299 M......Page 300 O......Page 301 P......Page 302 S......Page 303 Y......Page 304 The puzzling case of the broken arm The hernias, diets, and drugs Doctor doesn't know best: why physicians cannot know what will benefit patients Sacrificing patient benefit to protect patient rights Sacrificing a patient: societal interests and duties to others The new, limited twenty-first-century role for physicians as patient assistants Abandoning modern medical concepts: doctors "orders" and hospital "discharge" Medicine can't "indicate": so why do we talk that way? Medical necessity and treatments of choice: who's is fooling whom? Abandoning informed consent Why physicians get it wrong and the alternatives to consent: patient choice and deep value pairing The end of prescribing: why prescription writing is irrational The alternatives to prescribing Are fat people overweight? Beyond prettiness: death, disease, and being fat Universal but varied health insurance: only separate is equal Health insurance: the case for multiple lists Why hospice care should not be a part of ideal health care: The history of the hospice Why hospice care should not be a part of ideal health care: Hospice in a postmodern era Randomized human experimentation: the modern dilemma Randomized human experimentation: a proposal for the new medicine Clinical practice guidelines and why they are wrong Outcomes research and how values sneak into finding of fact The consensus of medical experts and why it is wrong so often. ... The author sheds light on a fundamental change sweeping through the American health care system, a change that puts the patient in charge of treatment to an unprecedented extent. The change is in how we think about medical decision-making. Whereas medicine's core idea was that medical decisions should be based on the hard facts of science--the province of the doctor--the "new medicine" contends that medical decisions impose value judgments. Since physicians are not trained to make value judgments, the pendulum has swung greatly toward the patient in making decisions about their treatment. [The author] shows how this is presently true only for value-loaded interventions (abortion, euthanasia, genetics) but is coming to be true for almost every routine procedure in medicine--everything from setting broken arms to choosing drugs for cholesterol. R.M. Veatch uses a range of fascinating examples to reveal how values underlie almost all medical procedures and to argue that this change is inevitable and a positive trend for patients. [Ed.] Robert Veatch, one of the founding fathers of contemporary bioethics, sheds light on a fundamental change sweeping through the American health care system, a change that puts the patient in charge of treatment to an unprecedented extent. The change is in how we think about medical decision-making. Whereas medicine's core idea was that medical decisions should be based on the hard facts of science--the province of the doctor--the "new medicine" contends that medical decisions impose value judgments. Since physicians are not trained to make value judgments, the pendulum has swung greatly toward the patient in making decisions about their treatment. Veatch shows how this has been true only for value-loaded interventions (abortion, euthanasia, genetics) but is coming to be true for almost every routine procedure in medicine, and uses a range of examples to argue that this change is inevitable and a positive trend for patients.--From publisher description