Regarding cases in which the patient refuses to participate in decision making I think it becomes incumbent on the provider to tease out the reasons for this (apparent) reluctance. Some reasons for refusal to participate in decision making may be addressed as separate issues to bring the patient into the process.

I’m thinking of educational background, societal expectations, language barriers and the structure of the medical visit (ie patient feels rushed and does not think that questions or discussion would be welcome).

In the past, such patients were almost a “bonus” to clinicians because they were less labor intensive, they moved the schedule along and went along with what was being proposed.

My suspicion is that the compliance by patients who were not actively involved in decision-making was less than optimal.

In an environment where ePatients are increasingly advocating to become participants in their own care, it will be important for care providers to get a grasp on whether or not all of our patients are participating in care decisions in a way that assures optimal outcomes. We certainly do not want to create an “ePatient divide” or a multitiered system of health information.

Thanks again, Howard.