Physician-Patient Communication

Shared Decision Making

Several decision-making models exist.  One option is the traditional informed choice model, in which information regarding the available options and their statistical success rates is presented objectively.  This exchange, also termed theindependent choice model, has been criticized because it removes the physician’s influence and guidance in the name of patient autonomy.  On the opposite end of the continuum is the paternalistic approach to medical decision-making.  This “doctor knows best” approach may spare patients the anxiety of making difficult choices, but the lack of patient autonomy is felt to outweigh any such benefit.

In between these two options is shared decision making, which combines informed consent with physician guidance.  In this model, the physician uses his or her knowledge and experience to help the patient choose the option that best matches that person's goals, values, and beliefs.  Some experts have suggested that every conversation addressing medical decisions should follow this model and include the six tasks listed below. (10)

Table 4: Elements of a Decision Making Conversation

Braddock CH III, Finn SD, Levinson W, et al. How doctors and patients discuss routine clinical decisions: Informed decision making in the outpatient setting. J Gen Intern Med. 1997; 12: 339-345.