Author Affiliation: General Medicine Unit, Massachusetts General Hospital, Boston.
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.
Barry MJ. Involving Patients in Medical Decisions: How Can Physicians Do Better? JAMA. 1999;282(24):2356–2357. doi:10.1001/jama.282.24.2356
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