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Editor's Note
March 2014

Talking About Patient Preferences

JAMA Intern Med. 2014;174(3):321. doi:10.1001/jamainternmed.2013.13478

We commend the mother of Yanling Yu, PhD, for her confidence in her own values and her courage in questioning her cardiologist about her need for an angiogram and stent. We hear so many stories from well-educated patients, including physicians when they are in the patient role, about how hard it is to question their physician for fear of upsetting the physician or being seen as a “bad patient.” But there is rarely only 1 clear correct way to manage medical problems, and patients should insist that their values and preferences play a major role in medical decision making. In this case, the patient’s preference to avoid an invasive procedure also turns out to be consistent with the evidence that medical therapy is as effective as percutaneous coronary intervention (PCI) for treatment of stable coronary artery disease and that PCI does not prevent myocardial infarctions. Luckily, Dr Yu and her mother were able to ask the questions that were important to them and choose therapy more in line with their own values. We wish that more patients could do the same and that more physicians routinely discussed alternatives and worked with patients to choose patient-centered therapy.