Shared Decision Making: New Paradigm for the Doctor-Patient Relationship
Article by Mary Lee Peters, MD
Seattle Plastic Surgeon
Who remembers Marcus Welby? If you do not, you may have escaped the era of paternalistic medicine where the benevolent doctor made all medical decisions on your behalf presuming he understood your goals and desires. The benevolent part of that picture matters a lot, but the "Father knows best" model shows a potential lack of understanding. Patients need to be able to express to their doctors what outcomes are most important to them. You need to know that your doctor (plastic surgeon) has respect for your values, preferences, and expressed needs.
In the information age, doctor patient relationships have changed a lot. People are hungry for health information. iphones have dozens of apps related to healthcare and fitness. Most people consult the internet to explore a health concern many times before they consult their doctor. Most will self diagnose or make medical choices based on their reading and then select a doctor that conforms to that choice. The doctor's opinion becomes optional in the search for autonomy in making critical decisions.
There is good and bad in that method, yin and yang. People are becoming more informed about the important decisions in their life and becoming proactive about their health. But often it is difficult to put all this information to good use. Healthcare webpages, advocacy sites, and chat rooms all provide both incorrect and correct information. It is hard for the reader to distinguish evidence-based advice from marketing hype. It is difficult to navigate between the extreme and the reasonable. It is harder still to figure out how that information applies to you, and what makes your circumstances unique.
That is where the doctor comes into the shared decision making process. Having used the internet to check the lay of the land, it is important for you to seek the guidance that only medical training and experience can provide. Ask your doctor how this information you have gathered can be put into perspective in your circumstances. Important decisions are best made in a partnered fashion. Come to the table informed, but keep an open mind about how to apply the information.