What is a Physician to do?

I am recoving for nasal surgery this holiday season and preparing to be both a teacher and a student this spring semester. I am thankful for the opportunity to become a student at Medical College of Georgia while continuing to teach at Albany State University.

In reading about ethics as related to medical care I read recently that ultimately decisions are to be made by the patient and the physician is responsible to fully inform the patient regarding all available options. But if I recall, physicians are also responsible to practice evidence-based medicine in order to do those things that have been shown to be be most effective given the diagnosis. Forgive me if I am missing something, but if the patient chooses the treatment how can the physician be responsible for the patient making choices that are not evidence-based? I have no problem with patients participating in decisions about their treatment. But is it realistic to hold the physician responsible to explain every option and every possible consequence of every option? Given the power of suggestion, is it really in the interest of the patient to be told every awful thing that might possibly be the result of a medical decision? And must a physician identify treatment options that are clearly far beyond the patient's scope of options for reason of cost? Might doing so be said to be unethical behavior? Under some form of managed care, telling the patient want is technically possible but not financially feasible is not going to earn the appreciation of the physician's employer and/or partners.

To me, a professional relationship involves agency and trust. Agency does not require a blind trust. Patients certainly should participate in their care and be as alert as the situation permits. But how can a physician fully inform patients of all choices, follow patients' choices, and also be held accountable to practice evidence-based medicine? We are going to need all the good physicians we can find in coming years. Let's define the practical and ethical responsibilities of physicans in reasonable ways in order not to cause good physicians to seek other lines of employment.