ARTICLE


ASIA CASEBOOK | VOLUME 19 | ISSUE 3 | SEPTEMBER 2011 www.medicalprotection.org


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Shared decision-making M


Poor communication lies at the heart of many complaints or claims from patients against doctors.1 Dr Jagdeesh S Dhaliwal, of MPS Education and Risk Management, looks at how shared decision-making can help improve communication


any doctors have noticed an increasing number of patients


who want to play a major role in important decisions affecting their health, including any treatment proposed by a doctor as part of their management plan. In the days when patients were more deferential, technical knowledge rested squarely with the profession. A “doctor knows best” approach was widely practised, and accepted as the norm. The days when doctors made decisions and patients passively complied are becoming distant memories for most doctors. In the 21st century a “doctor knows best” approach is at odds with the reality of our increasingly informed, educated and assertive populations – especially at a time where knowledge is instantly accessible to most via the click of a mouse. Many patients expect to be much more involved in decisions about their own healthcare. Research reveals that dissatisfaction with decision-making occurs in up to 58% of consultations. The majority of patients state that they would prefer a greater level of involvement in medical decision-making than they currently experience.2 For this reason, doctors


are realising the importance of developing advanced communication skills that actively promote collaborative and consensual conversations about healthcare with their patients.


GOOD DECISION-MAKING What constitutes a “good” decision? It is our experience as doctors that there is often no one correct answer. Medical evidence may be limited or conflicting, and particular circumstances may apply to the patient in front of us rather than the patient in the textbook. Our judgment in each instance emerges from a dynamic interplay between our knowledge of research evidence – the science of medicine – and the sum total of our experience –


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