Shortcomings in Education and Training

Perhaps we are nowadays more rationally thinking “physicians” than “real doctors”, almost pure natural scientists. Perhaps we only think about the diagnosis and the latest treatment trials and no longer about the patients’ understanding, wishes, or self-determination? The article by Katarina Hauser and colleagues, who likely had the good intention of opening the eyes and hearts of physicians to the need of involving patients in the diagnostic and therapeutic decisions, is rather difficult to read and ultimately is of low yield (1).

The unsatisfactory conclusions of this contribution are not surprising. There are after all different types of patients. Some prefer a detailed explanation and may raise many personal objections—which can be based on highly competent and justifiable concerns, or on less important reasons. Others do not want any part in shared decision making. They need confidence and are unsettled by information sheets, signatures, or detailed verbal advice. Therefore, physicians should simply develop a sense for this. This can and should begin during their studies—in lecture halls, during internships, and at bedsides—and should be transmitted to the assistants by the chief and senior physician visits, with constant reinforcement.

Intensive courses that teach the necessity of involving patients in patient-relevant decisions are, in my view, second choice at best (2). On the other hand, this probably can be taken as an admission of shortcomings in the education and training of young doctors—not only in their curriculum, but also in the personal role models displayed by many chief and senior physicians.