How hard should you try to convince a patient to do something?

The Wall Street Journal Health blog reported last week on an editorial in the Journal of the National Cancer Institute. The editorial considered whether it might be more worthwhile to invest money into improving cancer screening technologies such as mammograms, rather than spending that money on getting more patients to get existing, imperfect tests. Some patients may have a rational, logical and well thought-out reason for turning down an imperfect screening test. No amount of education campaigns is likely to change that decision.

The article points to a larger discussion of what the goal of physician counseling should be. Is the physician's goal to convince the patient to do what he or she wants the patient to do (i.e. get the screening test)? Or should the physician's goal be to simply counsel and educate the patient, and then let the patient make a decision? It is easy to say that the goal should be the latter, but in practice, this is difficult for both the physician and the patient. Physicians face the reality of practice standards and pay-for-performance schemes that say what tests a patient should get and when. And patients may not be willing to make difficult decisions or may make poor decisions no matter how much evidence is given to them. The task of counseling does not have any easy answers. But it seems that if 71% of women are getting a screening test, the reason the other 29% are not is not as simple as a lack of discussion.