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Patient-Doctor Relationship and Shared-Decision Making

By: Rosa Rios

For the past decade, we have experienced a three hundred and sixty-degree change in the healthcare system. The patient-doctor relationship has transitioned from a paternalist model to a partnership. This relationship has been supported by health technology, engineering, communication, and medical research among others.

Today the patient-doctor relationship is part of patient engagement strategies that promote patient self-care and decision-making. Indeed, patient engagement requires shared decision-making. Based on the International Patient Decision Aid Standards, shared decision making is a cooperative process that allows patients and doctors to make health care decisions together. It requires precise medical information and the patient’s ability to make mindful decisions.  The information must have the best clinical evidence available and must honor a patient’s values and preferences.

There are many organizations that promote patient engagement. They encourage the use of patient decision-making guidelines, which specify the principles of decision-making and patient engagement in health care. These principles are simple to understand; the patient decides, and the doctor explains treatment options. Is it that simple? Unfortunately, there is not national protocol for the implementation of decision aids for providers and patients. It is also unclear if patient decision-making is documented in the electronic medical record.

Informed Consent Is Similar But Not The Same

Patient decision-making is different from informed consent. Informed consent is a patient’s authorization of a particular health care intervention. The patient must be informed and agree to a procedure before the doctor medically intervenes or operates on the patient. Based on the Department of Health and Human Services, informed consent should contain details about the treatment options, side effects or possible complications, and alternative treatments. Most procedures require informed consent except medical emergencies that must be treated immediately. The main difference between decision-making and informed consent is that the latter is required for almost all medical procedures. In contrast to informed consent, decision-making is a generalized strategy for including patients in their health care.

Decision Aids

Patients and providers have decision aids. Decision aids are defined as any informational content that helps the patient and doctor make a decision about patient’s health care. Decision aids can be electronic calculators for disease risk, vitals signs, body weight, body mass index, genetic analysis, and lab testing among others. Patients and doctors can use these tools to decide the course of treatment and prognosis. Based on the information provided by decision aids tools, doctors can predict the risk of disease and create patient interventions that will decrease the chance of getting sick. For example, a patient who smokes can calculate his risk of lung cancer and the need for a lung cancer screening. Based on this data, patients can be educated about diseases and make more informed treatment decisions.

In conclusion, a patient-doctor relationship is based on agreement and cooperation. Without the patient’s ability to understand the reason for treatment and the importance of medical intervention, treatment success can be difficult to achieve. Patient decision-making strategies promote patient self-care and engagement in health care. Finally, the patient-doctor relationship is no longer paternalist; patients now have a voice and power during the medical encounter.