Road and the destination – Making the patient choose the treatment


The main problem I have with (making the clients choose the treatment) is this: What we do with our clients or patient should have plausible scientific reasoning and some supporting evidence. We should stand clear of modalities with no plausible scientific rationale and evidence that speaks against the modality.

As stated by Ingram et al.: “We recommend making a greater effort to focus our attention on biologically plausible methods that are congruent with our accurate patient-focused education processes” (1).

We should always listen to our patient’s preferences, feelings, wishes, and goals. But as I see it, these are only some of the factors. What we as health professionals think will most likely be the road to long term outcomes should be our primary focus.

There are problems focusing too much on patient satisfaction (2), which can have negative consequences. As I see it, our patients should choose the destination or the desired result. Still, we as professionals should provide options to the road ahead that will lead to the destination in the quickest, most efficient, and effective way.

Suppose we begin to let our patients choose our road to the desired result, and we let them interfere with our clinical reasoning and rationale. This is, in my view, a slippery slope and not a sign of professionalism. In my opinion, doing placebo treatments is also a slippery slope. Our treatments should not be based upon a mostly inconsistent and variable effect. The placebo effect is not set in stone. Prof. Patrick Wall once stated something like, “the placebo effect is not something administered to a patient; it is something to be elicited from a patient”.

Sometimes patient’s choice of treatments aligned with our selection; this is a win-win situation. But often, they do not know what the best treatment options they have are. That is part of the reason they come to us, in the first place.



1. Ingram T, Silvernail J, Benz LN, Flynn TW. A cautionary note on endorsing the placebo effect. J Orthop Sports Phys Ther. 2013 Nov;43(11):849-51.

2. Fenton JJ1, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012 Mar 12;172(5):405-11. Epub 2012 Feb 13.