Who’s the doctor here? That was the reply my wife recently got from her medical oncologist in response to a question concerning how long she would be on her current oral chemotherapy drug.
Normally such a response would have prompted me to make some kind of “smart remark” to the doctor. After all, I have done my homework on my wife’s condition and felt it was a reasonable question. I am also very involved in my wife’s medical care and am pretty wary of physicians in general. But in this case I was silent. This doctor had saved my wife’s life. This doctor had earned my respect, my trust and the right to make the tough decisions on behalf of my wife in her battle with lung cancer.
Some people may find my wife’s doctor’s reply “shocking”…too paternalistic. Others, like my 88-year old mother find nothing wrong with the doctor’s comment…it’s what she’s used to. The fact of the matter is that collaborative or shared decision-making is not appropriate for every patient all the time.
My experiences are confirmed by research. Numerous studies have shown that as many as 52% of U.S. adults prefer to leave medical decision-making up to the physician. Other studies have identified length of physician-patient relationship, preference for their current physician’s communication style, and level of patient trust as factors that help explain patients’ willingness to depend upon their physician for making important medical decisions.
Normally my wife and I like to have a “big say” when it comes to making medical decisions. But in the case of cancer, like others facing serious medical conditions, we were quite willing to look to past our preferences and depend upon a trusted physician expert to tell us what we should do. My point? Patients each have a predominant decision-making preference. However these preferences do shift from time to time particularly under certain seemingly predictable, high-stress situations.
So if you are a physician, how are you supposed to know which patients “prefer” collaborative decision-making and which do not? For starters you might try asking your patients.
Not All Patients Want to Participate in Decision Making – A National Study of Public Preferences, Levinson et al. Journal of General Internal Medicine. 2005 June; 20(6): 531–535.
Patient-centered Communication – Do Patients Really Prefer It? Swenson et al., Journal of General Internal Medicine. 2004;19:1069–1079.
Patient and Physician Attitudes in the Health Care Context: Attitudinal Symmetry Predicts Patient Satisfaction and Adherence. Christensen et al., Annals of Behavioral Medicine. 2007, 33(3):262–268.