When deciding whether to offer deep brain stimulation earlier than usual for Parkinson disease, it is important to consider not only the patient’s autonomy but also the validity of the evidence and concepts of harm that are being used to form practice policies.
Paul J. Christine, MPH and Lauris C. Kaldjian, MD, PhD
Shared decision making requires that physicians acknowledge their responsibility to the patient, their responsibility to be true to their own clinical judgment about the patient's best interest, their accountability to society, and the uncertainty of the evidence.
When deciding whether a pregnant woman will take antidepressants that pose a slight risk to the fetus, the patient and doctor must each make value-based determinations about whether absolute protection of the fetus is more important than preventing the mother’s probable suffering.
When a patient requests an unfamiliar treatment, the physician should not hesitate to research it before giving a categorical reply about its safety or efficacy.
Rachel O. Reid, MD, MS and Ateev Mehrotra, MD, MPH
An effective policy regarding retail clinics in a primary care practice should address patients' need for timely and convenient acute care and build capacity for enhanced access to acute care within the primary care clinic itself.
Patricia D. Quigley, MD and Megan A. Moreno, MD, MSEd, MPH
Maintaining an adolescent’s confidentiality while answering his or her parents’ questions about their child’s change in mood and behavior can be challenging.
The guidelines for patients’ eligibility for bariatric surgery have not changed since 1991, although recent data suggest there may be indications for broadening application of the surgery.
A discussion of the ethical issues raised by a patient’s request for off-label, prophylactic bariatric surgery to prevent diabetes mellitus type 2 (DM type 2).