Informed and shared decision-making: the crux of patient-centered care

• Published in: Canadian Medical Association journal (CMAJ) Vol. 165; no. 4; pp. 438 - 439
• Main Author: Weston, W W
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact, Inc 21.08.2001
• Subjects: Attitude of Health Personnel; Bioethics; Decision Making; Family medicine; Family Practice; Humans; Patient Participation; Physician patient relationships; Physician-Patient Relations; Professional Patient Relationship
• ISSN: 0820-3946; 1488-2329

Thirty-five years ago, when I was a medical student, we were taught to be paternalistic. We were trained to withhold information from patients, especially painful information about a potentially terminal illness; we were also instructed to take charge of interviews and to avoid getting "sidetracked" by patients' "irrelevant" concerns. The handbook that my university developed to teach the clinical method referred to the interview as "the interrogation." Patients who did not comply with "doctor's orders" were called defaulters, untrustworthy, unreliable or faithless.1 This paper by Godolphin and colleagues reminds us about our responsibility to engage our patients in the complex process of investigation and treatment planning; it points out some of the educational challenges we face, if we are to learn and teach the skills to succeed in this task. We can begin by recognizing the value of involving the patient as a partner and asking "What do you think?" more often. When the patient retorts, "You're the doctor," the physician should respond with a comment such as, "Yes, and I will provide you with information and my expert opinion, but I really do want to include your thoughts and wishes in our planning together." When you and your patient disagree about management, be sure to listen carefully to the patient's ideas and paraphrase them so that the patient knows that you understand his or her point of view. Then, express your concerns and engage in a discussion that seeks to find common ground. It is not always easy, but it is often interesting and rewarding.