Why shared decision-making in medicine often fails

One opinion

Excerpt: "Let us assume that physicians, especially PCPs, are provided with all the additional information everyone thinks they should have and that they have all the time necessary to impart this information, as needed, to every patient they treat. Would this result in the joint patient-provider decision-making touted as the “gold standard” of medical care? Likely not! To receive information, a patient must be both motivated and capable of learning, and far too often, they are neither. How frequently has a patient been prepared to take notes or asked to borrow a pen and paper to do this?

It frustrates me when experts and organizations preach this ideal but always fault the physician if the relationship falls short of this goal. However, a joint activity requires that both parties share equal responsibility for it to function effectively. Through observing patient-clinician interactions, I have found that the patient half of the dyad is frequently deficient, rather than the physician!

As I have written, at least half of the patients queried prefer their physicians to make decisions on their behalf and not be involved in the medical aspects of their care. Those who wish to make decisions may be unable to participate due to limited literacy (at or below the eighth-grade level), diminished motivation resulting from prior experiences, an inability to reason rationally and neutrally, or a combination of these factors."