Shared Decision Making

"The best interest of the patient is the only interest to be considered"

This sentence is from the 1910 Rush Medical College commencement address by W. J. Mayo, M.D.  The full sentence included an important requirement:

"In order that the sick may have the benefit of advancing knowledge, the union of forces is necessary."

These two statements have been updated with the terms Patient-Centered Medicine, and Shared Decision Making.

The concepts are far from new and current events make them very relevant.  In today's practice world where the ten-minute encounter is the norm, shared decision making becomes almost impossible. Physicians are between a rock and a hard place.  We need constant reminders in the face of mounting bureaucracy, coding requirements, and electronic health record data input.

The union of forces is necessary to meet these needs.  Nurses, educators, medical assistants all should be engaged with patients.  The addition of readily available teaching aids, and electronic aids can assist us with these duties.

The modern EHR has new functionalities which incorporate instructions and educational material that can be given to a patient at the encounter or made available via a portal or direct secure email to the patient. 

Patients and clinicians have different expertise when it comes to making consequential clinical decisions.  While clinicians know information about the disease, tests, and treatments, the patient knows information about their body, their circumstances, their goals for life and healthcare.  It is only collaborating on making decisions together that the idea of evidence-based medicine can come true.

This process of sharing in the decision-making tasks involves developing a partnership based on empathy, exchanging information about the available options, deliberating while considering the potential consequences of each one, and making a decision by consensus. This process -- sometimes called patient-centered decision making, empathic decision making, or shared decision making -- demands the best of systems of care, clinicians, and patients and as such remains an ideal.



The Mayo Clinic and the Minnesota Shared Decision Making Collaborative have developed a comprehensive paradigm to meet this need.

The study reported in the BMC Medical Informatics and Decision Making 2013, 13(Suppl 2):S2