Objective Professionals, Subjective Patients? Unbiased Thinking Facilitates Better, Multidimensional Treatment

Health-Related Quality of Life Assessment in Children and their Families: Aspects of Importance to the Pediatric Surgeon

We read this article with great interest because exploring the health-related quality of life (HRQOL) of our patients is crucial to guide our diagnostic and therapeutic actions to their very best.[1]

The authors stated that “the development of the HRQOL field in medicine was spurred not only by an evolving recognition of the subjective factor, but also by the increasing prevalence of chronic health conditions requiring long-term treatment and life-long care.”

In this way, the patients' judgement of their own situation is labeled as merely subjective, while the authoring health professionals implicitly express the medical system's claim to assess the patients' conditions in contrast to this in an objective manner.

“Objective” means “unbiased and balanced,” even “completely true,[2] ” and is regarded as clearly superior and predominant in comparison with subjectivity which “does not show a clear picture or is just a person's outlook or expression of opinion,”[2] and as such is limited by a certain perspective, emotions, personal interests, and possible swift changes.

Implicitly ascribing these categories of objective versus subjective to professionals versus patients is not appropriate in our sight, while correctly using these concepts opens the way for better multidisciplinary care, as can be shown hereinafter.

Every health care worker only has a subjective perspective, professionally trained—yes, but not at all free of personal interests and other limitations which sometimes may clearly contradict the patients' welfare.[3] On the other hand, many patients and patient representatives became experts in the realm of their own disease; on top of this, they acquired many professional competencies, even scientific or medical, in their own personal training.

The health care worker can only offer his or her professional subjectivity. This can be a lot, and hopefully turns out to be sufficient for the individual patient, but in chronic and multisystem health conditions, it often does not.

An example: the actually valid Krickenbeck's classification of fecal incontinence in anorectal malformations, as agreed on at a pediatric surgical conference without involvement of patient representatives,[4] lists the following grades of soiling:

• Grade 1: occasionally (once or twice per week).

• Grade 2: every day, no social problem.

• Grade 3: constant, social problem.

Grade 2: daily involuntary loss of fecal matter, without any social problems, hardly exists. On the opposite, the affected patients are severely burdened and restricted by this disability. In this point, the “objective classification” mainly serves the treating pediatric surgeon; it gives him or her a good feeling, in spite of a bad (postoperative) result, while the patients confirming this are answering socially desirable but conceal their subjective, yet truly bad situation.

The patients' own assessment of their multidimensional QOL deserves a multidisciplinary team to properly understand and meet their different needs. This is the only way to get closer to the ideal of objectivity and integrated, holistic care.

Centralization of care of rare malformations, and the setting up and sufficient funding of multidisciplinary teams in these centers, is mandatory to reach this aim and deserves all support of both the medical community and politics.

Publikationsverlauf

Eingereicht: 27. Januar 2021

Angenommen: 06. April 2021

Artikel online veröffentlicht:
14. Juni 2021

• References

• 1 Bloemeke J, Witt S, Bullinger M, Dingemann J, Dellenmark-Blom M, Quitmann J. Health-related quality of life assessment in children and their families: aspects of importance to the Pediatric Surgeon. Eur J Pediatr Surg 2020; 30 (03) 232-238
• 2 Difference between objective and subjective. Accessed July 12, 2020 at: https://keydifferences.com/difference-between-objective-and-subjective.html
• 3 Schmiedeke E, Schaefer S, Aminoff D, Schwarzer N, Jenetzky E. Non-financial conflicts of interest: contribution to a surgical dilemma by the European Reference Networks for Rare Diseases. Pediatr Surg Int 2019; 35 (09) 999-1004
• 4 Holschneider A, Hutson J, Peña A. et al. Preliminary report on the International Conference for the Development of Standards for the treatment of anorectal malformations. J Pediatr Surg 2005; 40 (10) 1521-1526