Shared Decision Making is a relatively new concept in the healthcare system that is gradually coming to the forefront of general healthcare practice on all levels (primary care, specialty care, PT, OT, psychiatry, counseling, etc.). It is the idea that the healthcare provider aims to "involve the patient in deciding the plan of care to the extent at which the patient desires or is comfortable". This means that when Shared Decision Making is utilized, you (the patient) have a say in your treatment plan. You and the provider work together to make the best decision that will work for you, both for your health, mental health, financial situation, etc. and there are many other factors that I wont bore you with that also can be influenced. Now you can imagine, like in the Grey's Anatomy drama, the doctor walking into the room, telling the patient and everyone what the plan is, then walking out before the patient can even get a word in….. this is NOT shared decision making. This is bad bedside manner. Now in an emergency setting, the lines are very very gray here… but in general practice and every day life you should have an opinion and a choice in what happens to you regarding your health decisions. This is also called patient autonomy.
Shared Decision Making is not a skill set performed by all healthcare providers. There are many out there that do not utilize this way of thinking and interacting or have any desire to create these types of relationships with their patients, however, I believe that it is incredibly important that patient's aim to seek out providers that create positive relationships to improve the overall healthcare experience and the outcomes of those experiences.
Research has shown that shared decision making can help the patient reach more resources, if needed, and improve the overall quality of care provided to the patient as well as their outcomes (get better, faster). In addition, the patient (you) have more "buy in" or "say" in what is going on with your body and how the health problem will impact your life.
In this regard, it is essential that you as the patient are informed of the pros and cons or alternatives to what the health care provider is suggesting. Being informed is key in making and joint decision with your doctor on your plan of care. This includes informed consent of a treatment or procedure. You have a right to know what treatment you are to receive, why that particular treatment, and what the risks and benefits are to the treatment. Ask your doctor or healthcare provider for this information, I do not recommend "Googling it". That is a very scary rabbit hole I don't recommend going down, because according to Google, everything leads to cancer or some other serious illness. If you do want to do research on your own, stick to accredited sources like pubmed or any of the government health websites.
One of my main goals in my practice is promoting shared decision making and patient autonomy among my patients. I had one patient that this really hit home for me and drove me to continue to pursue this need for patient advocacy in our healthcare system. He was a young man in his mid twenties that came to me with low back pain that began about a month ago. He had back pain before after a lifting accident and so he was trying to treat it the same way, but it wasn't getting any better. When he walked in to the clinic, the first thing I noticed was his limp. He had foot drop. This is when the muscles in the front of the ankle stop working to lift the toes up (think of when your lower leg falls asleep and you can't move it or wiggle your toes). This immediately made me aware of the likely severity of his back injury. I evaluated him briefly, but I was more concerned about the severity of his symptoms, how long they had been going on, and why he was sent to me and not a specialist. The young man told me that his doctor had sent him here because his MRI was the same as it was a few years ago. That is all the information I got regarding his MRI. Even in the doctors report, "same as 2 years ago". The young man said his symptoms were very different than the first time he had back pain. So the same day I decided to phone his doctor and requested that the patient get another MRI and be referred to a spine specialist. The doctor told me that he had already had an MRI and it was "the same as before", which told me nothing as I didn't have reports of either, and that PT should help. I felt down in my gut that PT was not going to work, but I talked with the patient and we decided to give it a try, even though I told him it may not fix the problem. We gave it a shot for 1 week and made no difference. I called up the doctor again and he shut me down regarding sending this young man to a specialist. The doctor also shut the young man down when he made an appointment and asked for the same thing. At this point, the young man was still having the same problem, and we were both getting very frustrated with what to do. He needed to see a specialist. I decided to make a strong suggestion that he needed to change to a different primary care doctor. Two weeks later, he had a new doctor, who was amazing and listened to her patient, had another MRI, and was referred to a spine specialist! He was scheduled for surgery shortly after and had a great outcome.
Had I not advocated for this patient and worked together with him on deciding what we should do regarding his care, he would likely have permanent foot drop and other lifelong issues due to his injury. If you don't agree with your provider, despite all of the evidence they provide to you, speak up and seek another opinion.
I think the most important thing to take away from this concept as a patient is that it is YOUR BODY, no one else's. Therefore it is YOUR decision what you do with it, what is done to it, and what you put in it. If the doctor/provider is suggesting/recommending something you are not comfortable with, then you need to ask more questions or more likely need a second or third opinion to allow you to decide what you feel is best for yourself and your quality of life. I am not saying that these decisions will be easy, or that it will be easy to get into seeing multiple specialist, but that it is important to make sure that, no matter what, the decision is YOURs and you are guided and helped by your healthcare provider (s). At the end of the day, you are the one who has to live in your body, not the doctor.
You only have one body. Take care of it. Find people to help you take care of it. But it is ultimately up to you.
Tips:
- Remember you know your body better than anyone else can
- Don't be afraid to ask questions or ask for clarification
- Write questions down before you arrive to your appointments
- Take notes during your appointment
- Be open with your provider about any concerns you have
- When in doubt, ask for a second/third opinion
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