Shared decision making unites physicians, patients
It’s been a long time since patients universally viewed their physicians as infallible and having the sole say in medical decisions.
The availability of medical information online, news of medical errors and malpractice and the emphasis on controlling healthcare costs have led to more patient involvement in medical decisions. For physicians, the growth in shared decision making has been driven by evidence that it leads to better care and a push by the medical establishment.
Though it’s getting more attention now, shared decision making is not new. In 1982, a presidential commission declared that practicing ethical medicine required giving patients the necessary information to form their own opinions and have those opinions taken into account in the ultimate treatment decision.
Yet in the 34 years since, study after study has found that shared decision making is not always used when it should be and, when it is employed, is often done imperfectly and unevenly. “How Patient-Centered are Medical Decisions?”, a study published in JAMA in 2013, asked patients to describe the decision-making process for 10 common medical decisions, including six most often made in primary care.
Respondents reported much more discussion of the pros than the cons of tests or treatments, although discussions about surgical procedures tended to be more balanced than those concerning medications to reduce cardiac risks and cancer screening. Decisions about back or knee replacement surgery generated the most patient-centered discussions; breast and prostate cancer screening the least.
“Discussions about these common tests, medications, and procedures . . . do not reflect a high level of shared decision making, particularly for five decisions most often made in primary care,” the authors concluded.
Perhaps it shouldn’t be surprising that shared decision making isn’t used more widely. It requires additional time and effort on the part of everyone involved, educating patients in complicated matters and a shift in the traditional relationship between patients and physicians.