Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How do you engage your patients in shared decision making?


Johns Hopkins physicians share pearls of wisdom for our second Question of the Week.

Connecting with Patients | March 14, 2018 | <1 min read


David Efron, MD, Johns Hopkins University School of Medicine

Every patient is different. Some patients want to know all they can about their disease process—others, often overwhelmed by their situation, want minimal information. Still others have limited comprehension of the complexities of disease and the potential outcome they’re facing.

The most important aspect to engaging the patient in shared decision making is to find a way to impart as much information as is necessary that will allow informed decisions. Knowledge, while not always happy nor satisfying, is power. This allows open honest discourse about what is possible, what is not possible, and what is likely.

Julie Hoover Fong, MD, PhD, Johns Hopkins University School of Medicine

To fully engage a patient in shared decision making, I simply ask—

What is important to you?

Using this as a starting point sets the tone to develop the rest of the conversation.

What do you think?

Do you want to add to the conversation? Please share!

Margaret Chisolm, MD, Johns Hopkins University School of Medicine

I listen to patients, first and foremost. Then I share with them what I think is going on and how best to help—a clinical judgement based on evidence and wisdom gained from experience. I couch this in an acknowledgement of any treatment preferences they have told me about previously.

For instance, I might say, “I know you’re not interested in an antidepressant medication, so let me tell you about some alternative treatments,” or, “I know you’re not ready to address your substance use disorder at this time, so…” I also talk about any risks and alternatives of these approaches to treatment with every patient. I then invite their additions, reflections, and questions on what I’ve just said. Finally, I respectfully honor their decision to choose no treatment or alternative treatments (with me or someone else, if needed).

One of my guiding principles is that every person deserves the dignity of living their own life, which includes making their own decisions about their own medical care.

Michael Crocetti, MD, Johns Hopkins University School of Medicine

Caring for patients is a true partnership. Clinicians know a lot about the disease and medicines, and patients know their bodies and how treatment plans can best be carried out. More than ever patients and families want to know about their options for treatment of a particular illness. On the clinician side this takes careful thought and time, but I believe time well spent. Taking the time to carefully explore treatment options with the patient will save time by decreasing unnecessary follow up appointments and improve compliance with the chosen path.

The first step is discussing the options with a patient, but true shared decision making occurs when the patient is fully engaged in the process. There are tools available to help patients read and visualize treatment options that best suit their needs. After reviewing options for care the clinician should ask the patient if they fully understand what has been discussed. Ask the patient to teach back to the clinician what they have heard.

The clinician should ask the patient what treatment option they prefer. If the clinician has a preference they should be clear to the patient why a particular treatment option is best for that patient, and ask the patient if they understand why. Shared decision making done well can improve patient satisfaction, treatment compliance, and overall health. After all, isn’t that what we are aiming for with every patient?

Roy Ziegelstein, MD, Johns Hopkins University School of Medicine

To me, shared decision making involves three steps.

First, I get to know the patient, including the patient’s goals and life circumstances, and – importantly – how the patient prefers receiving information (amount, timing, language, illustrations, metaphors).

Second, I share what I know in a way that is consistent with what I have learned in the first step.

Third, I listen…and I address any follow-up questions or concerns.

As part of all three steps, I make sure that if the patient wants someone else in the room (spouse, son, daughter, friend) that person is there, and if the patient prefers that no one is there, I find a time when we can speak alone.