Using Shared Decision Making as a Tool
Shared decision-making is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions. This is ne of the new trends allowing patients to directly participate in their care. The goal is to give the patient sufficient data to make an informed decision with the clinician to determine the curse of their medical care.
In the article, What is Shared Decision Making?, the author defines as a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences.
Traditionally medical care was 100% paternalistic, where Dr. Welby knew what was best in all situations. With the tremendous growth of information available the consumer can google all the information they may or may not understand. Even if they understand, they do not necessarily have the context to make appropriate decisions.
The provider is the person who adds the context, but it is easy for the provider to bias the process.
There are certain situations in medicine where shared decision making is inappropriate. A patient who needs life-saving surgery or immediate cardiac care should not create an excessive dialogue. Other not so urgent problems with multiple treatment options is another story.
There is one place where shared decision making can be used as a tool to eliminate medical-legal testing, CYA procedure, unnecessary hospitalizations, and the overuse of our extension and expensive pharmacopeia. This will also appeal to practitioners who believe in the motto, "Trust Me" and/or "In My Experience".
Keep in mind that any action has risks. While one might wish that the benefits of an action outweigh the risks, we all know this not to be consistently the case. Thus any decision on which an action or the act of inaction is based has risks, and a risk/benefit ratio can be surmised. Actualized risks have costs, the most central of which are risks to the patient and the patient's health, the secondary, and tertiary, tiers of actualized risks are litigation, blame, and social or interpersonal dispute regarding responsibility for the decision. In traditional care models, the physician bears the secondary levels of risk; indeed in Marcus' time there was little litigation, and the risk of a questionable decision was small. But in our current dominant medical model, there is considerable risk to the care of patients, and to shouldering the decision making process. Hence, medical care is expensive. Broad shoulders require huge payouts and large premiums.
In a share decision model, who would bear the risk? Would it too be shared? Or perhaps when the patient is a decision maker, he/she agrees to assume all the risk of the decision. How would the elements of a negligence claim be parsed? Duty, Breach of Duty, Proximate Cause, Damages. Shared decision-making may be an advance, but some pieces have to be in place. For example, standard forms upon which a doctor checks off the options, risk, recommendations, and the patient perhaps on the other side of the sheet notes his acceptance, decisions, and signature. More forms, that's for sure. Lots more forms.
Take advantage of the consumers' willingness to participate in their care by having informed discussion with them. Talk with them like a family member, and give them the same advice. The monetary savings will be astronomical and your public relation scores will sky-rocket.
If you follow this process, it is important to document the discussion and who the participants were. Xpress Technologies EHR extension sections on clinical course, mini-macros and easy to use voice activated technology along with appropriate discussion help the provider implement the shared decision making technique.
