One of today’s core ideas was the vital importance of shared decision making in a safe and patient-centered health system. So many considerations enter into the process of shared decision making – the involvement of friends and family, patient advocates, or health proxies; the inclusion of a multidisciplinary care team in the conversation; making time and space for patients to come to decisions without feeling unduly rushed or pressured. Our conversations on the subject brought to mind an experience I had as a patient in the healthcare setting a few years ago.
I’d gone to see a physician for a problem that I understood only poorly, for which I had attempted self-care unsuccessfully at home. When the problem failed to resolve itself, I knew the wise thing to do would be to involve a health professional. Her recommendation was that I seek an appointment with a surgeon, a prospect that was at once shocking and terrifying. When I expressed concern about what I could expect from that encounter, she admitted that my condition lay outside her typical realm of expertise and clinical experience. However, her next step impressed me to no end: she beckoned me over to the computer terminal in the exam room, and showed me a professional online resource that she recommended for more information. Together, we read about the causes of my clinical presentation, then learned about my options for treatment and the risks and benefits for each.
What a concept! That she could admit that she was not as familiar with my problem as she would prefer to be, the better to offer me guidance and advice, and we could learn something new about my health together. One of my earlier posts focused largely on the intolerance of uncertainty in medicine, but I did not touch on a critically important consequence of that intolerance: our tendency as care providers to overestimate our knowledge on a subject and ad lib, shooting from the hip when we cannot summon more precise information. This bad habit puts patients in harm’s way every day, and is entirely avoidable. All that is necessary is for us to be willing to come to terms with what we do not know, and further willing to seek out new information.
Emphasis is placed in training programs on the idea that future physicians should have “a passion for lifelong learning.” Indeed, these words are used to describe the characteristics that medical schools and residency programs are seeking in their students. How can we live by such a value if we are reluctant to continually fill in the gaps in our knowledge? I know that I could work harder to avoid guessing when I don’t know the answer to a question. This mistake has become particularly egregious now that smart phones and tablets have made the wealth of available medical information instantaneously accessible. Furthermore, several websites exist solely to provide physicians and their patients with pre-written “decision aids” that provide information about health conditions and treatment options with which to start a conversation about a shared decision. I am happy to have yet more cause this week to recommit myself to the willingness to say “I don’t know, but I can try to find out,” or, more accurately, “I don’t know, but we can find out together.”
This step, so often skipped in the decision-making process, has the potential to be immensely powerful to countless patients who stand to benefit from being offered the most complete information available while making choices about their care. Indeed, I believe there is nothing less than an ethical imperative to do so.