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Clinical Decisionmaking

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Physicians welcome patients' participation in medical decisionmaking

Physicians appear to have a positive and flexible approach when it comes to including patients in clinical decisionmaking, concludes a study supported by the Agency for Healthcare Research and Quality (HS11289). Researchers interviewed 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired physicians. The physicians identified three primary justifications for including patients in decisionmaking: respect for autonomy, better health outcomes, and self-interest.

Physicians stressed the importance of patient autonomy and the patient's right to make decisions affecting their own health. However, patient autonomy was not the sole or even primary justification for many. Many physicians engaged patients in decisionmaking largely because they hoped it would result in better health outcomes. They believed that involving patients in decision-making promotes trust and honesty that leads to better diagnosis and care. Several physicians felt that they gained significant legal protection by involving patients in medical decisions. They believed that an informed patient would be more satisfied and less likely to sue them if complications arose.

Physicians integrated patients in decisions in different ways. Most saw themselves as an expert who has the responsibility to explain the clinical situation to the patient and make recommendations. Some doctors deliberately promoted a collaborative approach by inviting the patient to participate directly in the decision by outlining treatment options and allowing the patient to make the choice. Time spent discussing decisions with patients varied with patient level of education, intellectual capacity, ability to understand the decision, and patient's desire for education and participation.

See "Missed expectations? Physicians' views of patients' participation in medical decision-making," by Amy L. McGuire, J.D., Ph.D., Laurence B. McCullough, Ph.D., Susan C. Weller, Ph.D., and Simon N. Whitney, M.D., J.D., in the May 2005 Medical Care 43(5), pp. 466-470.

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