“Shared decision making occurs when a health care provider and a patient work together to make a health care decision that is best for the patient. The optimal decision takes into account evidence-based information about available options, the provider's knowledge and experience, and the patient's values and preferences.”
Shared decision making. It is not really a buzz word. I guess you would call it a buzz phrase, but it is on everyone’s lips if you are a clinician in healthcare. On the face of it, it makes all the sense, but it is thrown around too much without really thinking it through. As I have shown you in my last two posts, carefully considering the potential risks and benefits of a proposed medical treatment is very serious business. The five steps in the picture are great. As presented, it is a feel-good path, but if you look at Step A (assess), you must ask about the patient’s comprehension of the options available.
The key to effective shared decision making is in bold print in the quoted definition quoted above. That is where it often fails in our current system. Brilliant laypersons may have very limited information on medical issues. Our environment is loaded with misinformation and disinformation from many sources. A barrage of advertisements from the medical industry are all about profits and not about your health. It is very easy to be confused and a five-minute session with your doctor cannot possibly be effective. Especially for chronic conditions, it is important to build a base of understanding of the medical evidence that can support a shared decision with the patient.
My last two posts have discussed the unnecessary surgical procedures that literally millions of Americans have that at best are ineffective and dangerous at worst. Every one of those procedures is done with the consent of the patient. Shared decision making did not work in any of those unnecessary procedures.
That is where the concept of teams comes in. Building a base of medical information that will support shared decision making takes time, and you as a patient know from experience that your doctor does not have the amount of time needed to support effective shared decision making. This is where nurse coaches and nurse practitioners make such a difference. It is where resources like this site come in. You need enough good, trusted, evidence-based information to help you participate in guiding your own health care.
The topic that I know best is heart artery disease and related conditions like diabetes and high blood pressure. Many times, patients receive very confusing information and that is why care paths and protocols are so important. When every member in the team is trained with the same optimal medical therapy protocol for diabetes, you can be sure that the message is consistent, and that your team is reliably teaching evidence-based care processes consistent with best practices. A patient with that level of support can effectively participate in shared decision making. A patient with heart artery disease who has this type of team-based care is ten times more likely to survive years compared with the care that most of us receive. You can have that kind of care in your community.
So, let’s get started!
I can tell you that my wife’s experience concerning treatment of her back pain was not effective shared decision making. The link goes to a separate post with more detail on this encounter. The spine surgeon provided a five-minute summary of his proposed surgery versus a steroid injection into a facet joint. Then he looked at my wife and said, “What do you want to do?” According to the diagram, he had met the criteria, but it would have led to an unnecessary procedure. She had an autoimmune disease, not a spine problem. The choice was flawed. Of course, you would do a minimally invasive steroid injection to see if it helped before proceeding with radical surgery. It would have been worse than ineffective. Our system requires drastic revision to effectively deal with this problem. Nurses trained in coaching to provide trusted medical information are an important part of the puzzle. Medical information sources free of conflicts of interest are important also.
Sadly, “trusted carefully vetted objectively independently thoroughly investigated evidence based information” is willfully lacking. Unaccountable “expert opinions based narratives” are everywhere. They ALL have ulterior motives, mostly are used to serve self interests.