What is shared medical decision making? It is making sure you not only understand your health-care choices, but also participate so that your values are understood and respected. While many still use the term “doctor’s orders” to describe the tests and treatments carried out after a visit, they should be based on open discussion and your well-informed acceptance of the plan.
Let’s say, for example, that you have just been told by your doctor that you have high cholesterol, and you should take a lipid-lowering medicine. Many times after giving this advice in my own practice, the response I hear is, “OK — you’re the doctor.” While I am grateful for the vote of confidence, I would rather be sure that the treatment plan balances both standard of care, and my patient’s well-informed choice. Too often, people don’t take their cholesterol or blood pressure medicine because they feel fine without it. Patients who really understand what the drugs are for are more likely to take them consistently and reap the benefits.
Colon cancer screening is a good example of why decision-making should be shared. Gloria (not her real name, but being used to protect her privacy) is a patient who had avoided screening for years until she heard about a stool test that can be done at home as an alternative to colonoscopy. The stool DNA test does not require the dreaded cleansing prep, nor do you (and a driver) need to take a day off work. I explained to Gloria that, if the stool test were positive, then she would need to follow up with a colonoscopy.
A shared decision, right? Almost.
Her test turned out positive, and her colonoscopy was (thankfully) normal, yet Gloria was upset with me, and rightly so. I gave her all the right advice, but failed to explain that just because a stool test is positive, it doesn’t mean you have cancer. There can be “false positives” – an abnormal stool test followed by an entirely normal colonoscopy.
Not understanding this, she spent weeks after her positive stool test dreading her expected cancer diagnosis. If I had been more clear, she might have elected to go straight to colonoscopy. At the least, she might have had a less anxious waiting period.
Doctors do our best to provide clear information, and we welcome your input on all decisions that affect your health. But no one expects you to be your own doctor. We just want to be sure that you leave the office feeling confident in your treatment and follow-up plan. Here are some questions to help you share in decisions about your care:
- How will I benefit from taking this test or medicine? This may be a simple explanation of the recommended treatment, and why your doctor thinks it will help you.
- What does a positive or negative result mean? These are straightforward vocabulary words, but their medical implications aren’t always obvious. Gloria’s is the case in point.
- What are the risks or potential side effects? All tests, medicines, and treatments have potential undesired effects. The information you receive online or at the pharmacy can be very scary and overwhelming. Your doctor can help put these risks in perspective.
- Are there other options? Don’t be shy about expressing your concerns about a medicine or a test, whether you’re worried about the cost, the side-effects, or how much time it will take. And you can always ask whether you need to make a decision right away.
Studies have shown that when patients feel well-informed and thoroughly heard, they are much more likely to follow through on recommendations from their doctor. This results in better satisfaction with care for both patient and doctor, along with better treatment outcomes. Ultimately, that’s what we’re really aiming for.