Allergist Dr. Lauren Fine: "Stop Asking for Permission"

I'm curious, you had described almost There are different ways to approach engagement with families and patients.

Of course, I'm a pediatrician, so I take care of children and families, but there's a paternalistic way or maternalistic way of thinking about it where the doctor knows what they need to do and tells the patient what they need to do versus more of a shared decision-making where we're all on the same team.

And there's much more disclosure of information.

In fact, you said that you go to Italy often.

And I have read in some places in Italian medical culture, especially with older patients with cancer, they don't say the word cancer.

And they don't let their families know that the patient know that they have cancer, but the families do.

And probably the patient does, but they don't talk about it.

which is almost the extreme form of paternalism.

So what has been, I'm not an internal medicine nor am I an allergist.

What has been your training around that? Do you feel like you're more of a shared decision-making kind of physician or is it easier to be paternalistic or maternalistic in the care of adults?

David, I have had very few patients who actually wanted a paternalistic approach.

They'll tell you, for the most part, if that's what they want.

And usually it comes out because I am trying to take that shared decision-making approach to it.

And they just say, just tell me what to do.

You're the doctor.

You know better.

I'm not going to make decisions here.

You can lay it all out for me, but you know better.

And The shared decision making for me was not something I was actually taught.

And it's not because anybody failed to give me the curriculum.

I think it depends on who you learn with at the bedside, what their style is.

And I think when I went to medical school, which was a long, long time ago, it was 2002 to 2006.

I hate saying that sometimes.

I'm like, wow, I'm getting old.

When I think about the way that we were taught, it was very much, okay, go in and take the history and do the physical and do the labs and the imaging, whatever you need to do, and tell the patient what they need.

I'm curious, you had described almost There are different ways to approach engagement with families and patients.

Of course, I'm a pediatrician, so I take care of children and families, but there's a paternalistic way or maternalistic way of thinking about it where the doctor knows what they need to do and tells the patient what they need to do versus more of a shared decision-making where we're all on the same team.

And there's much more disclosure of information.

In fact, you said that you go to Italy often.

And I have read in some places in Italian medical culture, especially with older patients with cancer, they don't say the word cancer.

And they don't let their families know that the patient know that they have cancer, but the families do.

And probably the patient does, but they don't talk about it.

which is almost the extreme form of paternalism.

So what has been, I'm not an internal medicine nor am I an allergist.

What has been your training around that? Do you feel like you're more of a shared decision-making kind of physician or is it easier to be paternalistic or maternalistic in the care of adults?

David, I have had very few patients who actually wanted a paternalistic approach.

They'll tell you, for the most part, if that's what they want.

And usually it comes out because I am trying to take that shared decision-making approach to it.

And they just say, just tell me what to do.

You're the doctor.

You know better.

I'm not going to make decisions here.

You can lay it all out for me, but you know better.

And The shared decision making for me was not something I was actually taught.

And it's not because anybody failed to give me the curriculum.

I think it depends on who you learn with at the bedside, what their style is.

And I think when I went to medical school, which was a long, long time ago, it was 2002 to 2006.

I hate saying that sometimes.

I'm like, wow, I'm getting old.

When I think about the way that we were taught, it was very much, okay, go in and take the history and do the physical and do the labs and the imaging, whatever you need to do, and tell the patient what they need.