Gastroenterology

Not so long ago, clinical hepatogastroenterology was almost limited to relieving ulcers, calming the colopath, monitoring liver cirrhosis, and accompanying the cancer patient. Ethics, above all, was associated with the tone of the relationship with the patient, which was then at its peak, and was protected from the media, litigation, user associations: adapting one's attitude and speech in the presence of patients from very different social backgrounds; not abuse healing power or excessive paternalism. You can use the gastroenterology service on the website of the aesthetic cosmetology clinic.

The explosive growth over the past 20 years, with diagnostic and then interventional endoscopy, the advent of anti-cancer chemotherapy or long-term treatment of inflammatory diseases, which finally became effective, radically changed the principles of our discipline. To the ethics of fair conduct was added the ethics of sound medical decision, which must be preceded by a quality discussion. I would like here to highlight some of the new challenges that surround this decision-making process.

From Medical Paternalism to Autonomy: A Difficult Path for All

Today's patient, more informed because he is often more educated than in the past, and who remains more and more independent and outpatient in his illness, no matter how serious it may be, only the decision that worries him? This principle seems attractive to the clinician who is convinced that his idea of ​​what is "good for the other" is shared by the person who counsels him. The reality seems quite different: each patient naturally feeds on his beliefs, priorities, his own temperament: rather an "ant", he will invest in life hygiene strategies and preventive examinations, even in case of risk, in order to gain several years of life. life ; rather a "cicada", he would rather wait in the wings, evading the doctor's advice.

However, the gradual evolution of medical paternalism towards autonomy is not without problems. The most sensitive of these concerns ways of organizing discussion that can help involve the patient, thus enlightened, in the decision-making process. Indeed, choosing between two therapeutic strategies or deciding whether to undergo an invasive examination or not, the patient is not in the position of a judge. The argument does not have as its basis the privileged space of the court with its rules and logic. How then can he remain neutral in his assessment of the elements of the charge (risks) and the defense (benefits)? Burdened with rights and statutes, the patient often feels very lonely and helpless.

Loyalty, adaptation and timing

The doctor who informs him must, for his part, overcome three main obstacles:

• do not overemphasize your therapeutic preferences and honestly disclose the respective benefits of the alternative;
• tailor the content and form of the information to the personality of the interlocutor, without succumbing to the temptation of a crude and necessarily incomplete list of risks, as the Anglo-Saxons can do.

to find time for continuous and evolving information when the time of a consultation or visit is not always sufficient for the rational and effective communication of basic data about a medical problem.