Comments on: Domhnall MacAuley on shared decision making http://blogs.bmj.com/bmj/2009/06/19/domhnall-macauley-on-shared-decision-making/ Just another blogs.bmj.com weblog Tue, 24 Nov 2009 05:34:23 +0000 http://wordpress.org/?v=2.5.1 By: Amy Neil http://blogs.bmj.com/bmj/2009/06/19/domhnall-macauley-on-shared-decision-making/#comment-4515 Amy Neil Tue, 14 Jul 2009 14:59:29 +0000 http://blogs.bmj.com/bmj/?p=718#comment-4515 Perhaps one of the difficulties with the concept of shared decision making (SDM), is that it doesn't fit neatly into a 'framework'. There is no 'task flowchart' for SDM that will optimally suit all individuals (patients AND clinicians) in all scenarios. I was a patient with a chronic illness within the NHS for 10 years, before returning to my native US. In my experience, niether system is ideally suited to SDM. In fact, I don't think the SDM issue should be linked to payment, structure, or to any other organizational discussion. Rather, we should consider focusing on the underlying philosophy of SDM within the wider context of medical care -- that all patients (and clinicians) are individuals and we can never presume to know or to fully understand their experience. However, we can learn how to hear their experience, which will then guide us in presenting and delivering care options. Ideally, clinicians should be able to do this without fear of legal repercussion. While I acknowledge that 'money' issues impede ideals, socialised medicine, in my experience, was not immune from this phenomenon. However, the UK now seems to be at the leading edge in promoting increased focus on the patient experience of care, via organizations such as the Picker Institute. It is this return to underlying fundamentals, I think, that will enable us to effectively address current healthcare quality reform issues, including SDM. Perhaps one of the difficulties with the concept of shared decision making (SDM), is that it doesn’t fit neatly into a ‘framework’. There is no ‘task flowchart’ for SDM that will optimally suit all individuals (patients AND clinicians) in all scenarios. I was a patient with a chronic illness within the NHS for 10 years, before returning to my native US. In my experience, niether system is ideally suited to SDM. In fact, I don’t think the SDM issue should be linked to payment, structure, or to any other organizational discussion. Rather, we should consider focusing on the underlying philosophy of SDM within the wider context of medical care — that all patients (and clinicians) are individuals and we can never presume to know or to fully understand their experience. However, we can learn how to hear their experience, which will then guide us in presenting and delivering care options. Ideally, clinicians should be able to do this without fear of legal repercussion. While I acknowledge that ‘money’ issues impede ideals, socialised medicine, in my experience, was not immune from this phenomenon. However, the UK now seems to be at the leading edge in promoting increased focus on the patient experience of care, via organizations such as the Picker Institute. It is this return to underlying fundamentals, I think, that will enable us to effectively address current healthcare quality reform issues, including SDM.

]]> By: Domhnall MacAuley http://blogs.bmj.com/bmj/2009/06/19/domhnall-macauley-on-shared-decision-making/#comment-4422 Domhnall MacAuley Tue, 23 Jun 2009 11:28:48 +0000 http://blogs.bmj.com/bmj/?p=718#comment-4422 Dan and Talya, thank you for responding. I am pleased that it is unclear- I tried not to favour any particular viewpoint as I wanted to reflect accurately the different strands of opinion at the conference. There are many different opinions and I know this is a debate that the US health care system will have to address in the near future with the proposed Obama health reform. The concept of socialised medicine is very controverial in the US while many European countries favour some collective responsibility. If, as Talya proposes, patient movements take ownership it will be interesting to see if they opt for the benefits to the individual or to society. Dan and Talya, thank you for responding. I am pleased that it is unclear- I tried not to favour any particular viewpoint as I wanted to reflect accurately the different strands of opinion at the conference. There are many different opinions and I know this is a debate that the US health care system will have to address in the near future with the proposed Obama health reform. The concept of socialised medicine is very controverial in the US while many European countries favour some collective responsibility. If, as Talya proposes, patient movements take ownership it will be interesting to see if they opt for the benefits to the individual or to society.

]]> By: Dan Matlock http://blogs.bmj.com/bmj/2009/06/19/domhnall-macauley-on-shared-decision-making/#comment-4420 Dan Matlock Mon, 22 Jun 2009 18:36:53 +0000 http://blogs.bmj.com/bmj/?p=718#comment-4420 It is unclear what Dr. MacAuley is proposing. It seems as if, in the name of public health, he is advocating a system where patient and family preferences are not considered in medical decision making. Here in the United States, our legal system has clearly rejected this as evidenced by the court cases of Karen Ann Quinlan, Nancy Cruzan, and more recently Terri Shiavo. It is unclear what Dr. MacAuley is proposing. It seems as if, in the name of public health, he is advocating a system where patient and family preferences are not considered in medical decision making. Here in the United States, our legal system has clearly rejected this as evidenced by the court cases of Karen Ann Quinlan, Nancy Cruzan, and more recently Terri Shiavo.

]]> By: Talya Miron-Shatz http://blogs.bmj.com/bmj/2009/06/19/domhnall-macauley-on-shared-decision-making/#comment-4413 Talya Miron-Shatz Sat, 20 Jun 2009 19:38:52 +0000 http://blogs.bmj.com/bmj/?p=718#comment-4413 Patients of the World, Unite! During a conference Q & A session, an audience member inquired where is the patient movement, claiming shared decision making? It is perhaps not surprising that patients often fail to demand to be involved. They are either too overwhelmed, concerned they might offend ther doctor, unaware the option exists, or, sadly, too sick. And sometimes, they just don't get what the health professionals are talking about. See http://blogs.psychologytoday.com/blog/baffled-numbers It if for us the health professionals and decision scientists, rather, to further the work that those who preceded us have thus far so nobly advanced. Even if this good fight is not yet fought by the people, we can do our best to fight it for them. Patients of the World, Unite!

During a conference Q & A session, an audience member inquired where is the patient movement, claiming shared decision making?
It is perhaps not surprising that patients often fail to demand to be involved. They are either too overwhelmed, concerned they might offend ther doctor, unaware the option exists, or, sadly, too sick. And sometimes, they just don’t get what the health professionals are talking about. See

http://blogs.psychologytoday.com/blog/baffled-numbers

It if for us the health professionals and decision scientists, rather, to further the work that those who preceded us have thus far so nobly advanced. Even if this good fight is not yet fought by the people, we can do our best to fight it for them.

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