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May 10, 2000

How Should Physicians Involve Patients in Medical Decisions?

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(18):2390-2392. doi:10.1001/jama.283.18.2387

To the Editor: Dr Braddock and colleagues1 found that 91% of patient-physician interactions failed to meet their definition of informed decision making. However, this snapshot approach ignores the context of the patient-physician relationship. Every intervention is negotiated with each patient, and both sides have expectations based on prior interactions, which lay the groundwork for a productive relationship. Each interaction, however, must stand on its own merits. If we fail the patient's expectations this time, next time we have to rebuild or the patient will need to start over somewhere else. Patients become comfortable with a relationship, which varies in its paternalism or autonomy depending on the decision at hand. Trust, therefore, is earned. Without it we have to go through a cumbersome decision framework bit by bit, warily sparring back and forth until there is a comfort level of trust.

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