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December 22/29, 1999

Involving Patients in Medical Decisions: How Can Physicians Do Better?

Author Affiliations

Author Affiliation: General Medicine Unit, Massachusetts General Hospital, Boston.

JAMA. 1999;282(24):2356-2357. doi:10.1001/jama.282.24.2356

Increasingly, clinicians are being encouraged to involve patients in their medical decisions, both diagnostic and therapeutic. Such shared decision making is particularly important when the optimal management strategy depends on the strength of patients' preferences for the different health outcomes that may result from the decision. In such a circumstance, the optimal strategy may be quite different for 2 patients with different preferences facing the same decision about a diagnostic test or course of therapy. Failure to match the treatments that patients receive with their preferences (including their attitudes toward risk) may contribute to the phenomenon of widevariations in rates of medical treatment for many conditions by geographic area,1 which suggests to some observers that physicians', rather than patients', preferences are driving these rates. Evidence of this push toward shared decision making abounds. For example, national guidelines from the American College of Physicians/American Society of Internal Medicine on questions as diverse as prostate-specific antigen (PSA) testing2 and estrogen replacement therapy3 have recommended that clinicians provide patients with information on the pros and cons of their options and help them reach an individualized decision about the right course to take.