Shared Decision Making — shared with whom?


What is Shared Decision Making (SDM)?  It is a process for patients to make good decisions about tests, medications, surgeries and just about anything health care providers might suggest.  What it is, and what it is not — some examples:

A patient has frequent headaches and has a visit with a provider.

Scenario 1:  The provider says “a CT scan of the brain is needed, so get that done and come back for a follow-up visit.”  (Old school, doctor knows best)

Scenario 2:  The patient wonders if a CT scan of the brain would be a good idea to make sure there is no brain tumor.  The provider says “sure, the nurse will schedule it tomorrow.”  (Consumerism, do what the patient wants)

Scenario 3:  The provider says “there are a number of options including a trial of migraine medications or getting a CT of the brain.”  Then the provider gives the patient a handout that lists independent sources for additional information.  And, says “I will call you on Monday, after you have had a chance to review the information so we can decide what to do”  (Shared Decision Making)

Group Health Cooperative in Washington State has made a big push to support SDM.  The Group has made information available on the Internet to assist the patient for many common situations.  91% of patients who used the system found it “very important” or “extremely important”.  Click to see an Example of shared decision-making by Group Health Cooperative.

Pros and Cons:

  • The process takes longer than just doing what the provider says
  • Usually the SDM comes to a decision the patient will support, so they will follow instructions and treatments more than an average patient.
  • As long as the information reviewed by the patient is based on evidence based guidelines (well researched advice) then good decisions are possible.  And, usually the decisions are less invasive and less costly.

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