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Informed consensus: How to work with patients to achieve positive treatment

Physicians and patients often follow different paths to reach a plan for care. Shared decision-making may pave the way for agreement.

By Susan J. Landers, amednews staff. April 5, 2004.

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Talk may be cheap in the cliche, but not in physicians' offices, where a single discussion on a contentious issue such as hormone therapy or prostate cancer screening can take longer than the 15 minutes allotted for the entire visit.

But discussions about medical options that balance a patient's values, preferences and understanding with therapeutic gain should not be overlooked. There is new evidence that "shared decision-making" can be beneficial to patients and physicians.

For starters, such discussions might enhance compliance.

Peter Ubel, MD, an Ann Arbor, Mich., internist and director of the University of Michigan's Program for Improving Health Care Decisions, says he is likely to prompt a discussion on hypertension medication by asking his patient, "Why do I care about your blood pressure?"

"It's a great way to see what their understanding is about their risk factors," he says. Some patients equate hypertension with emotion and believe if they don't feel pressured or tense they don't need to take their pills. "If you want patients to take their pills every day, it's good for them to understand why."

Shared decision-making is a trend that appears poised to follow informed consent as an important standard of care. At the very least it can help physicians and patients find a comfortable perch along a continuum that ranges from physician paternalism to patient autonomy.

Its momentum is propelled by several forces.

One is the baby boomers who came of age questioning authority. "In the '50s when I grew up, professionals -- doctors, lawyers, policemen, priests -- were considered gods," says Annette O'Connor, PhD, professor at the University of Ottawa's Faculty of Health Sciences. "Certainly the baby boomers didn't go for that."