When I speak to a group on the subject of healthcare, many of the same questions come up. Generally, they fall into one of three categories:
- Inquisitive. These are people who are seeking to gain more information or clarification regarding something I said.
- Frustrated. These questions reflect an unsatisfactory experience with the healthcare system or the politics surrounding the Affordable Care Act.
- Accepting. These are the questions I always find most intriguing; they reflect an acceptance of a paternalistic model of physician-patient interaction.
I find this third category most interesting because it reflects an approach and perspective that is quickly coming to an end: the physician as all knowing, infallible decision-maker.
For example, when I speak about the advantages of preparing a written agenda for a physician meeting (we covered this in the February 2013 edition of this newsletter), many people are taken aback. Although it makes perfect sense to them to prepare an agenda when attending a business meeting, in the context of their own healthcare or that of a loved one, nine times out of ten they ask,“But how do physicians react to that?”
The answer is, “very positively.” Because while the underlying assumption in this question is that the physician would object to a patient being politely assertive and prepared, the opposite is almost always true.
Just last week, in fact, when I attended a physician appointment with an 88-year-old, very complicated client who was recently hospitalized and with whom I was attending numerous specialist appointments, the physician said about our agenda, “I’ve never seen anything like this before. You just made my job really easy, thank you.”
And yet, an individual physician’s response is really beside the point. As healthcare moves to a patient-centered model of care in which the concept of Shared Decision Making is employed, it is incumbent upon all of us to take responsibility for our medical treatment.
Shared Decision Making
In speaking to the audience in Florida, I gave the example of a client’s care from five years ago and compared it to today, now that the client is a member of an Accountable Care Organization and a Patient Centered Medical Home.
The fundamental difference is Shared Decision Making, a term which describes a collaboration between a physician and a patient in which they come to an agreement about healthcare decisions. After all, there are many times when there is no “best” treatment option. Shared Decision Making involves a dialogue in which the physician helps the patient understand the outcomes of the options, appreciate the risks and benefits and, most important, define his or her preferences.
A wonderful example of this occurred recently with an older adult client of mine. After listening to all the reasons why she should be eating pureed foods – swallowing issues; risk of aspiration of food into her lungs; the potential to develop an infection – she said the following: “I’ve lived a very long life and because I’ve lived so long, I’ve lost a lot. One of the greatest pleasures in life that I continue to enjoy is eating. I’ll be sure to use the strategies my speech therapist taught me to reduce the risk of aspirating, but eating soft foods is as far as I’m going to go. Do not puree my food.”
(Reading this article titled This Old Man reminded me of her and how much she enjoyed not only food, but being hugged.)
Your relationship with your physician
Just as we study the effectiveness of medical treatment plans, we’ve studied Shared Decision Making. Some things we’ve learned as a result of using this approach:
- Patients had increased knowledge
- Patients had a more accurate understanding of risk
- Decisions were made consistent with the patient’s values
- There was reduced internal conflict for patients
- Fewer patients remained passive or undecided
In addition, and in certain circumstances, screening and invasive surgical options are chosen less often with this new approach, a result that speaks to questions of over-diagnosis and over-treatment with our current system.
The overall point is simply this: Health care delivery is changing to a patient-centered model, one that requires your thoughts, ideas, preferences and goals. To participate equally in future healthcare decision making, it is critical that you develop a relationship with your physician in which information is openly shared, both of you listen to each other and decisions are made together.
The old fashioned paternalistic approach just isn’t going to work anymore.