Shared Decision Making: An Interview with Mayo Clinic Professor of Medicine Victor Montori

the shared decision-making to to be very conceptual is essentially a fancy word to describe a conversation and it is a conversation between at least two parties one party is the clinician traditionally considered the source of expertise about the decision and the other party is the patient traditionally considered the subject of the decision that the victim of the decision if I may this gets redesigned such that now the patient becomes an expert in their own life patients will tell you I don’t like to take pills I’m not very good at taking pills or when I take pills my body doesn’t like them and so I get all outside if they have expertise or I talk to my neighbor my neighbor has had this they have knowledge that they have it could be correct or incorrect but it’s knowledge that they have and they bring in so instead of ignoring it it is honoring it and it’s bringing into a conversation where they can share that the clinicians can share their bit and then they engage in that you know in the second phase after sharing that information where they deliberate they consider the options and they they sort of consider the pros and cons of each of the options pros and cons are considered in the context of the patient and in relation to what patient value and pursue and from that process the option set narrows down to perhaps the next best thing we can do together one of the ways of clarity of describing this is how I experienced when I was a small child and my grandfather was sick and we were all in the hospital with the adults pacing around a set of closed-door some of them were smoking at the time they were smoking in the hospital you know pacing and pacing and waiting and then the doors will swing open and three or four clinicians will come out with their white coats and basically inform us we’ve made a decision we’re going to operate right so the process of information sharing with the family about the options if it existed was the minimum requirement for essentially from consent right in terms of deliberation it all happened behind closed doors among the doctors if you think of a single doctor it will all happen in the doctors head with no access the patient will have no access to that process and and to understand what were the issues that were given greater weight and what were the issues that we’re dealing less be no input at all in our study which now includes you know several thousand of instances of shared decision-making use what we’ve identified is that on average cert decision-making interventions extend the consultation by about ten percent other evisceration so for a consultation in primary care of say twenty minutes it is a two to three minute extension anything that enhances transparency and accountability Healthcare can begin to reduce the corruption of healthcare shared decision-making is one strategy in which we make the options available clear in which we empower the patients to consider those options and to express their goals I think clinicians have a moral obligation to actually do everything they can to provide that level of transparency – as you should making process and and to feel that they are accountable with patients for those outcomes if you’re a young health professional and you want to participate in a patient revolution you see this system as it is and you will be an agent of change share decision-making is one of the ways in which you you manifest that if that spirit are that commitment to a patient revolution

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