Shared decision making

Shared decision making based on both evidence and patient preference is popular in the medical literature of late.  I don’t understand why anyone would object.

'Taking a history’ is one of the first clinical tasks medical students are taught. The logic behind this is inescapable: without the history, attempts at diagnosis and treatment are doomed to failure. We start our training with the history, when we present patients for discussion with other doctors (in training or later, in practice) we start with the history. And except in rare emergencies, we start every patient interaction with the history.  The history: it always starts there but it doesn’t end there.

In a previous post I talked about some important questions I ask myself in my attempt to avoid missing the correct diagnosis.

There is also a set of questions I like to ask the patient, usually at the conclusion of the visit while I am typing our collaborative assessment and plan into the EHR, to ensure that the patient and I are literally on the same page. 

Information is the currency of medical care. Transparency is the way it is vetted. Communication is the way it is shared.  Collaboration is the way it generates patient-centered outcomes. The right information must always be available to the right people at the right time in the right format.

And, by ‘available to the right people’ I don’t just mean the PCP or the consultant.

I mean the patient. 

When your clinician suggests a test, here are seven questions you should consider asking. (And if you are a clinician, you should be asking yourself these questions before you recommend the test.)

He had called and asked for medication for his cholesterol because he had been told by his wellness program at work that he needed to be on medication for his cholesterol to prevent a heart attack.  He didn’t understand why he needed to take time off work to come in and discuss the risks, benefits, and options before I would prescribe anything. And he was irritated that his wife was making a big deal about it. 

There are five requirements for successful shared decision making (SDM) between patients and their clinicians.

Shared decision making based on both evidence and patient preference is much in the medical literature of late. The part I don’t understand is why anyone would object.

Before you decide about treatment, you should ask about NNT and NNH. These are numbers that can help you understand how likely the treatment is to help (or harm) you. They are easy to understand - though they can seem confusing to calculate.