Surviving AmericanSurviving
American Medicine

Doctors have been talking about shared decision-making by patients with physicians for over a decade, at least since the Institute of Medicine reported “Crossing the Quality Chasm” in 2001. But for you to have your voice heard in making decisions about your own health care, doctors must be giving you honest and complete background information about your condition, and be discussing the pros and cons of proposed treatments.

In a recent analysis, authors concluded that less than 10% of documented patient decisions are truly “informed” with good understanding by patients of their choices (N Eng J Med 2013; 368: 6). Only 41% of patient decisions reflected the patient’s own preferences. This is poor performance by physicians and their staffs.

When patients receive more information, 20% choose to have less invasive therapy. Use of decision aides (printed information about pros and cons of surgery) reduces surgery by 38%.

Here are my tips for you:

Work with your doctor to make decisions

• You should ask your physician and the staff in the office for more information about a proposed treatment.
• Increasing the documentation you receive should include the doctor’s experience, as well as printed information about procedures or treatments (from medical device manufacturers, drug companies, and also printed publications from the medical literature).
• Get more information from patient support groups, and organizations (e.g. American Heart Association, American Cancer Society as examples)
• Make your decision only after discussing the choices with your family or friends who can serve as your support group (your advocates).
• If you are having trouble making a decision, get a second opinion. If your doctor does not give you enough information about the proposed treatment, get a second opinion.

See my new book Surviving American Medicine for tips in Chapter 11 on Getting the Right Answers and Chapter 15 on Second Opinions. You can get better health care.