THE FIRST COMMANDMENT

Thou shalt have no aim except to help patients, according to the goals they wish to achieve

When deciding on a treatment, the first diagnosis you need to reach is about the nature of the illness. The second diagnosis you need concerns what the individual would like to achieve. Both are of equal importance and this is as true in simple one-off encounters as in complex lifelong illness. But the balance needs particularly careful thought when beginning long-term treatment.
Always make sure that you understand your patient’s aims before you propose a course of action. It may require three minutes in a situation like an acute sore throat, or years of ongoing dialogue in a situation like multiple sclerosis or heart failure. Do not assume that you know what your patient has come for, and do not assume that the treatments you have on offer meet the goals of everyone in the same way.

Useful Links

Less is More Medicine  - a wonderful resource of information about doing more with less created by Jessica Otte

Spironolactone Case by Richard Lehman - a clinical example that exemplifies most of the Ten Commandments

Key Papers

May C, Montori VM, Mair FS.
We need minimally disruptive medicine. BMJ 2009

Fun and Informative Videos