Many patients and doctors are still used to the paternalistic attitude of physicians when it comes to decision making, expecting the doctor to make a recommendation and the patient to say yes. While this is still appropriate in some cases, in many conditions, patients have a lot of choices to make. Doctors should put the patient in the driver’s seat rather than decide for them, and act more as advisors and advocates. Making decisions in this collaborative way is called shared decision making.
Take for example coronary artery disease (CAD) with angina, a common condition where plaque narrows the blood vessels in the heart, which causes chest pain while you walk. This condition can cause heart attacks, but in the majority of cases takes a benign course and acts more as a nuisance rather than an imminent threat. CAD can be improved by exercise and smoking cessation, along with medications that control the growth of plaque. More often than not however, patients are treated by placing stents in their heart – a procedure that can be risky, is not guaranteed to work, and is costly to the patient. Studies have shown that stents are not superior to medications, but often are used because doctors favor them over medical management, despite proof that this attitude is not justified. Furthermore, surveys have proven that patients who have received stents are often not informed of the above and think stents are safer and superior to medications.
Multiple studies have suggested that engaging patients with shared decision making reduces the number of unnecessary surgeries by about twenty to thirty percent.
The above has led to include the provision of shared decision making in the list of prerequisites required to gain an Accountable Care Organization status by a health care system. Health care is expected to be centered on the patient and not the doctor.
In the office of a physician practicing shared decision making, you will be encouraged to ask questions and be notified if there is a choice that you have to make. You may be given brochures describing your situation and choices or be directed to web based education material. Your doctor is likely to draw pictures for you while explaining a surgical procedure, and is likely to ask you if you understood everything before you leave the exam room.
With shared decision making, you will feel that when it comes to your health, it’s all about you.
By: Ibrahim G. Eid. MD, FACS
Michael Rothberg et al. Patient and cardiologists’ perceptions of the benefits of PCI for stable coronary disease. JACC March 9, 2010, Volume 55, Issue 10A
O’Connor, AM. Decision aids for people facing health treatment or screening decisions. Copyright 2009. The Cochrane collaboration. Published by John Wiley and Sons, Ltd
Woolf, et al. Promoting informed choice: Transforming health care to dispense knowledge for decision making Ann. Intern. Med. 5005;143:293-300