For patients to participate in their treatment planning, clinicians must first share knowledge and insights. From this foundation, shared decision-making may be possible.
A recent article in the Wall Street Journal entitled “Can Patients Decide Their Own Care?” prompted me to reflect on patient-centered care. The medical profession has moved from “the doctor knows best, no need to ask questions,” to shared decision-making. But how is this best employed in patient care, especially when clinical decisions are complex?
A family member recently told me of an experience in the hospital. Their spouse had a procedure, and this family member was asked to which service they wanted their spouse admitted. The family member had no medical background and no information about the pros and cons of either option. Absent any information, they had to guess at the best choice. Later events showed the alternative would have been better.
Patient and family-centered care isn’t just asking patients and family members about what they want to do. Rather, it means they’re empowered to be informed decision-makers. Without the information with which to make an educated decision we leave the patient and family feeling at best overwhelmed and at worst alone.
I’ve been guilty of this, mostly in how I word questions to my patients. After reviewing how their symptoms have been faring since the last appointment, I know what I think the next step should be, but sometimes I first say to the patient, “What would you like to do?”
Occasionally my young adult patients say, “I don’t know. I’m not the doctor.” I go through the options and offer my professional opinion of what I think we should do and why. In my efforts to first seek out their opinion I can make them feel unsure. Though I still sometimes fall into this trap, I now first present options, explaining why I think one or even two options are reasonable choices based on my clinical perspective. Then, I ask about questions or concerns they have and what choice they’d like to move forward with. Getting past “the doctor always know best,” to patient-centered care, in which decisions are collaboratively made, is what’s best for optimal patient care. We need to be mindful as clinicians to make decisions together with patients rather than setting them adrift to find their own way.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.