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The Conflict of Choice

Shared decision making is the pivot on which modern medical ethics rest. Doctor appraises patient of the choices available. Doctor supplies evidence and lays out the pros and cons. Patient has the intervention of choice. We are all happy.

But...Where does medical responsibility meet patient autonomy?  Shared decision making is much more than us all simply agreeing to disagree: it’s dirtier and messier.

This is from a thoughtful essay by Margaret McCarthy, The Conflict of Choice, in the BMJ: Download Margaret McCartney: The conflict of choice - bmj.h5312.full

Shared Decision Making

Recently, there was an excellent introduction to Shared Decision Making (SDM) in the Medical Journal of Australia.  SDM is a very important concept, and sadly, it is rarely encountered in medical practice at this time.

A useful precis appears in the MJA article:
"Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments."

Shared Decision Making:  What clinicians need to know and why should they bother.