Patient participation in decision making


Category : General, Medical Rants

One major change in medicine since my internship (1975) is the manner in which we make decisions. In 1975 the physician generally told the patient what needed to be done. Now we are encouraged to engage patient in making clinical decisions.

An article in the June Journal of General Internal Medicine examined this concept (disclaimer, JGIM is the official journal of SGIM and I am President-Elect of SGIM). Here are the results of a population based survey.

Nearly all respondents (96%) preferred to be offered choices and to be asked their opinions. In contrast, half of the respondents (52%) preferred to leave final decisions to their physicians and 44 % preferred to rely on physicians for medical knowledge rather than seeking out information themselves. Women, more educated, and healthier people were more likely to prefer an active role in deicision making. African-American and Hispanic respondents were more likely to prefer that physicians make the decisions. Preferences for an active role increased with age up to 45 years, but then declined.

These results probably do not surprise any practicing physicians. We have a responsibility to assess our patients desire to participate in decision making. At times we must become salespersons, when we feel strongly about a desirable course of action.

This article reinforces the concept that we must treat each patient as he/she wishes. We cannot make rules which cover all patients. Developing individualized decision making strategies represents one more skill which would should learn. And, I believe, this is good.

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Comments (2)

Nice post, DB, with much food for thought. It occurred to me that it may be difficult to ensure that the patient’s decision making is evidence-based, and I blogged about it today.

Grand Rounds #45

Welcome to Grand Rounds #45. I am pleased to offer a rundown of excellent medical and health-related posts to the masses. I hope you enjoy the wide array of posts offered today! Don’t forget to thank the bloggers for their exceptional work. .:Alois:….

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