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Voices of Shared Decision Making with Leana Wen

Posted on July 16, 2013 by the Informed Medical Decisions Foundation, IMDFoundation

Each "Voices of Shared Decision Making" blog segment features a person we believe has a unique and valuable perspective on shared decision making.

In your own words, what is shared decision making and how does it improve the quality of health care?

As the patient, you have vastly different values and priorities than other patients and, likely, from your doctor. Any decision about your health should take into account your values and priorities, and that's what shared decision-making intends to do. It acknowledges that you are the expert when it comes to your body and your values, and that the doctor is the expert in medicine. It's only with an equal partnership between you and your doctor that an accurate diagnosis can be made, and it's only with this equal partnership that the right treatment can be decided—for you. Shared decision-making is the way that medicine SHOULD be, because it is only with this partnership that you get personalized care to you.

What do you think are the misconceptions of shared decision making?

One misconception is that the patient has to know everything. I've heard patients ask why they should have this role, when in fact doctors are the experts and are hired for their expertise. But shared decision-making takes their expertise into account. It's simply involving patients in that decision-making process, to make sure that the information is easily and readily accessible in a way to allow the doctor to guide the patient to make the decision right for him or her. You don't need an MD to know what is best for you.

Another misconception is that shared decision-making is only important for the treatment. However, diagnosis is the critical first step before any treatment is done. Your doctor needs your help to figure out your diagnosis, and shared decision-making needs to begin long before any treatment is done: it has to start with figuring out your story, and your diagnosis.

What has to happen for shared decision making to be part of standard practice? Who do you think should lead this change? (ex., patient, provider roles)

Tip O'Neill once said that "all politics is local". I believe in the corollary, that all medicine is personal. Any change in medical practice has to take place with the two parties involved, the patient and the doctor. With shared decision-making, both have to take an active role. The doctor needs to be comfortable with presenting and discussing options, and the patient needs to ask for these options and a value-centric conversation. This may sound hard for both parties, but as with most things, it is an acquired skill, and providers and patients alike must practice to incorporate SDM into their everyday practice.

Do you have a personal story about you (or someone you know) who has or could have benefited from shared decision making?

My mother was diagnosed with metastatic breast cancer when she was in her forties. When she first became ill, she had a number of symptoms that her doctor just couldn't figure out. Initially, they blamed it on her being a teacher—surely she was exposed to many little kids and many viruses. Then, they blamed it on her being depressed or anxious. By the time she was diagnosed, she had been misdiagnosed for nearly a year.

The root of her misdiagnosis was that her doctors just were not listening to her. They assumed that they knew what was going on, but never sought to figure it out. She was never involved as a partner in her diagnosis. Had she been incorporated from the start as an equal partner in her diagnosis, she probably would not have suffered so much—and perhaps her cancer would have been caught at a much earlier stage.

If you could change one thing about how we practice medicine today, what would it be?

Medicine has become increasingly disconnected. Patients and doctors are both well-intended, but they are doing different things with different goals and different means. If I could do one thing to change medicine, I would make our system of care patient-centered, to focus on what really matters to patients. Change research priorities so that they address what matters to people, not researchers. Treat people, not their organs (or their wallets). Address care of the whole person, including preventing their illnesses. We are a long way off from getting a just, equitable healthcare system, but starting with a patient-centered focus is a critical step to getting us there.

Leana S. Wen, MD, MScLeana is an attending emergency physician and director of patient-centered care research at George Washington University. She is the author of the critically-acclaimed book, "When Doctors Don't Listen: How to Avoid Misdiagnosis and Unnecessary Tests."For more information, visit her blog The Doctor is Listeningor her website. Follow Leana on Twitter @DrLeanaWen.

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