Wednesday, August 24, 2011

More on Patients and “Shared Decision Making”

About 10 days ago I tweeted this, "How can a patient, who does not know what meds she is on or why, seriously participate in 'Shared Decision Making'"

After receiving several negative comments about the tweet, I blogged in detail about patients not knowing what meds they were taking and finished with this:

“While I’m on shared decision making, I have this final comment. Physicians should not present three options with lengthy dissertations on the myriad side effects of treatment and no real advice as to what would be best for the patient. You cannot teach someone the anatomy, physiology or the nuances of medical care in a shared decision making discussion, especially if that patient can’t even remember what his meds are.”

Thanks to MedPage Today’s rather indirect mention of a poll involving patients and my superior internet research skills, I discovered this recent study from the Journal of Medical Ethics. Investigators at the University of Chicago surveyed 8308 hospitalized internal medicine patients and found that after hearing their options and being offered choices, 67% preferred to leave medical decisions to their doctor.

As I said before, I always review the options with a patient, listen to their concerns and answer their questions. But as the majority of patients themselves believe, I think I am in the best position to recommend the appropriate treatment. Maybe a better term than “shared decision making” would be “shared information.”


Shannon Brownlee said...

A phrase in the last sentence of the abstract of the U of Chicago study you cite was telling: "effect was small." In survey work it's easy to come to the wrong conclusion by asking questions in the wrong way, so I guess I'm less persuaded by this study that most patients want the doctor to make important decisions. Many patients, yes, of course. Most? Maybe not.

More to the point, should you the physician be making decisions for patients about elective procedures? For instance, should you decide whether or not a woman with early stage breast cancer gets a mastectomy or lumpectomy with radiation? They are equivalent in terms of mortality benefit, but obviously very different in terms of their effect on the woman's life.

Skeptical Scalpel said...

Thanks for commenting.

I agree surveys can be manipulated but 67% qualifies as "most" to me.

I agree that when two treatments have equivalent results, a patient who understands the risks and benefits of both can certainly choose.

Anonymous said...

This may be a bit pompous, but I often tell patients, "Look. . .you have a bad (gallbladder/appendix/colon, etc.) and the only treatment is surgical in 2012. You don't really have a choice--unless you want to just go home. Sure there are risks...bleeding, infection, death...but you HAVE to accept this because, unless you're calling a cab, let's go to the operating room."

The patient almost always say, "Thanks,'re right...where do I sign?"

Skeptical Scalpel said...

I agree with you. For many of the things we do,especially emergencies, the patient has little choice. I do tell them that observation is an option.

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