Real talk: it’s taken the medical profession far too long to embrace transparency with our patients — and many of us still have some distance to cover before we get there.
But shared decision making — in which the doctor and the patient work together to determine a course of care — is the future of medicine. It’s part and parcel of the growing care management model, which puts patients at the true heart of a holistic, wellness-first, team-based approach.
And this shared decision making aligns with what patients have come to expect from their non-medical experiences. After all, this is the age when data underpins every course of action, from reviews that guide us to the right car dealer, restaurant and, yes, doctor to insights on Peloton instructors to how much we might like the newest buzz-generating novel. It only makes sense that patients with endless information at their fingertips will seek a proactive role in their treatment.
Despite the reticence some clinicians might feel, there are some big positives to a more open, information-rich exchange with patients. Here are the top three reasons why shared decision-making is a plus.
Building greater trust with the patient. One of the biggest frustrations caregivers have with patients is not getting the information that’s needed for them to be effective. How many times have you treated diabetic patients who are too ashamed to share that they’re having trouble keeping their blood sugar stable? Or teens too shy to ask questions about becoming sexually active? There are many reasons that can get in the way of patients sharing the information we need to serve them to the true best of our ability. But the number-one inhibition is trust. When we adopt a shared decision making model, we show patients we care about hearing their perspective and that we respect them enough to include them as a partner in their own care. This is an extraordinarily important first step to creating trust with patients.
Autonomy is important. Entering the great maw of the American medical system can be intimidating for patients. Depending on how serious the condition is, patients can feel overwhelmed, anxious, frustrated, defensive, even angry. All of that stems from the uncertainty of dealing with difficult or confusing diagnoses — made worse by an overly complex system. But shared decision making puts some control back into the hands of the patient. When you sit down with your patient and explain the options, including benefits and drawbacks, you communicate your trust that the patient is capable at a time when it’s useful to be reminded of one’s own strength. When you listen to their concerns, questions and experiences in a judgment-free way, you reinforce that the patient is right to trust you — and the patient will continue to open up.
You will drive better outcomes. In a shared decision making model, the patient isn’t pressured, cajoled, or talked into a course of treatment. They don’t have to “buy in” to your recommended treatments because it’s a path you’ve created together. That means adherence and compliance are higher, which typically results in better outcomes. And in the instances when a regimen doesn’t seem to be working or perhaps is producing adverse effects, patients are much more likely to recognize that something’s off and proactively seek advice and a new direction.
In the old days, there was a distinct us-versus-them attitude, a hierarchical vibe, where the clinician and the patient existed in separate tiers. That led to some very paternalistic, often unethical approaches that ultimately undercut faith in the profession as a whole, to the detriment of both providers and patients (I’m thinking of how, for example, it wasn’t until 1979 when a majority of doctors told patients about their cancer diagnoses). Today, aided by movements like open notes, breakthroughs in technology, new approaches like care management, and modern patient expectations, shared decision making is remaking how doctors and patients interact.
It will be our future standard — and it’s absolutely for the better.