Shared Decision Making in Health Care

With the ongoing saga of the Democratic Primary, and the upcoming presidential election, we will all be hearing more and more about the cost of health care in this country. While the debate at the national and state levels will certainly influence the lives of many down the road, what about the decisions that we make (or don't get to make) when we're in the doctor's office? Recent work by Bob Kaplan and Dominick Frosch at the UCLA School of Public Health suggests that while people in some parts of the country get a lot more stuff done to them medically (tests, procedures, etc.), people in those areas don't necessarily have better health outcomes. There is a lot of uncertainty in the medical profession, and in many cases, there isn't necessarily one "best" course of treatment.

Kaplan and Frosch point out that there are a lot of things about an individual patient that a doctor can't know from lab tests (like how important certain quality of life issues are to you, how much risk you can tolerate, etc.), and suggest that patients and doctors engage in "shared decision making." That is, when patients and docs communicate about quality of life issues and patient preferences, and when patients play an active role in consulting with their physicians, patients feel more in control over the illness, and may actually have better physical health outcomes. Also, on a broader level, after fully understanding the risks and benefits, many patients may elect to go for less invasive, and often lower-cost, options.

Some may object that doctors don't have time for this type of treatment, but most studies looking at shared decision making suggest that interventions designed to make patients more active participants in the conversation actually don't increase visit lengths. So, next time you have a reason to see the doctor, find out about the treatment options available to you. Bringing a tape recorder to your visit may help you remember the pros and cons of options presented by your provider so that you can consider them outside of the doctor's office. Ask questions when you don't understand, and find out what the implications for quality of life are given the options presented to you.

Examples of decision aids for selected conditions (that you might use to help prepare you to speak with your provider) can be found here.

For more info on costs and care, check out this interactive tool, recently posted at the New York Times.