Shared decision-making (when you’re wearing the paper gown)
One of the most critical aspects of shared decision-making is also one of the hardest. As physicians, we need to be comfortable with a patient making a choice that we might not make ourselves. Perhaps we would choose to observe an otitis media in our own afebrile 6-year-old, or maybe we would not opt for semaglutide to treat our own obesity. Patients can have a different set of values and experiences driving their decision-making. The principles of shared decision-making teach us that our training and experience are not the priority in every situation.
In my case, the radiologist may have assumed that because I had gone through all of the testing, I believed that screening did far more good than harm and that I would be back in 6 months. From my point of view, I saw the screening as more of a mixed bag; it was possibly doing good, but at the risk of doing harm with false-positives and the possibility of overdiagnosis. She also may have been pressed for time and not had any available point-of-care tools to help explain her decision-making process. I left without understanding what the evidence was for close-interval follow-up, let alone having a chance to share in the decision-making process.
Shared decision-making and evidence-based medicine are closely connected concepts; the decision rests on the evidence, and the evidence cannot be applied to patients without asking their perspectives.5 Mackwood et al4 point out that shared decision-making can be implemented with little to no increase in the time we spend with patients, and at no substantial increase in costs of care.
Shared decision-making is a skill. Like any skill, the more we practice, the more capable we will become with it. And frankly, it doesn’t hurt to remember how we’ve felt when we’ve been the patient wearing that paper gown.
