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In Reply It was good to read the comments of Symvoulakis and colleagues about our recent article on how decisions are made.1 To inform and involve patients in medical decisions is a goal that is valued to varying degrees around the world. It also poses major challenges for health care clinicians around the world, perhaps most acutely in primary care. The writers provide a good list of the problems: the wide variety of medical problems seen in primary care, lack of skills or practice in doing shared decision making, and physicians’ concerns that patients will not do something that they think is medically valuable. It will take some adjusting for physicians to feel comfortable when patients do not make the decisions they would recommend. However, as the writers state: “…striving toward a well-informed and actively involved patient…should become a priority for any health care reform to succeed over time.” We could not agree more.
Fowler FJ, Gerstein BS, Barry MJ. Patient-Centered Decisions in Primary Care—Reply. JAMA Intern Med. 2014;174(3):475. doi:10.1001/jamainternmed.2013.12843