Author Affiliation: Department of Medicine, VA National Center for Ethics in Health Care, NYU School of Medicine, New York, New York.
In their article, Ubel et al1 have provided additional data to assist physicians in helping patients make better health care decisions. While their results are unambiguous, the authors' conclusions may benefit from further consideration. Their methodology described physicians providing a recommendation based on a fixed set of circumstances relating to the risks, benefits, and alternatives of a particular intervention. Although the authors mentioned that “the best choice . . . depends on the relative value a given patient places on avoiding these complications vs reducing his or her chance of death,”1(p631) they did not include or account for this critical element of the shared decision-making process, that is, eliciting a patient's values.2,3 Shared decision making is a process of “decisions that are shared by doctor and patient and informed by best evidence, not only about risks and benefits but also about patient-specific characteristics and values.”4(p766) Their methodology leads to a physician recommendation that is made in the abstract rather than one based on a patients relevant values. This article may help to illustrate what is so important about the ideal of shared decision making—that a failure to elicit a patients values results in recommendations that more reflect what a physician would choose for themselves rather than what their patients want.
Alfandre D. Physicians Recommend Different Treatment for Patients Than They Would Choose for Themselves. Arch Intern Med. 2011;171(18):1685. doi:10.1001/archinternmed.2011.457