Time for a Cultural Change
Written by Editor   
Wednesday, December 13, 2017 08:12 AM

Health systems need to do a better job of defining shared decision-making and getting doctors to use it. In school doctors are told to get rid of ambiguity and figure out what the “right” answer was for a patient’s problem. We buy into this myth that there is a right answer, but two people can choose differently and both be right for the same problem if it aligns with what’s important to them. We need to start a culture where conversation starts with what the reasonable treatment options are and why might people choose one over the other.

Healthcare professionals want the best care for their patients. This is not about a profession being the villain, but a question of attitudes. Are we achieving what could be achieved for the people we seek to serve?

For decision-making to become truly shared, three aspects of practice will need to change. Who are we serving, and to what extent are we doing that well?  In addition, the healthcare structure has to enable this to happen.

Another problem is that physicians often don’t have the information needed to help people make the right decision.  People are flying blind. The current scientific enterprise cannot keep pace with the information needs of people and patients.

Patient attitudes also play into the need for more shared decision-making. People expect to be told what to do. “People want to be told what to do -- they're scared, they're anxious ... They can’t handle the truth,” said one doctor.

Finally, we need the incentives lined up.  Financial toxicity is real to the people in this country; financial adverse events can be disabling just like physical adverse events if we’re not addressing those, we're not helping patients make the right choices.