Informed Medical Decision-Making: the challenges of doctor-patient communication

You can’t be well empowered if you hear advice wrong. That’s why, in a participatory relationship, an essential skill is accurate handoff of information.

The Foundation for Informed Medical Decision Making, catchily pronounced “fimdim,” has been working for years to improve patients’ knowledge of options and alternatives. In today’s Boston Globe Liz Cooney talks with people from FIMDM about the issue. Excerpt:

What doctors explain and what patients understand might be two very different things, recent research suggests.

Ideally, patients talk with their doctors about the pros and cons of a particular treatment, weighing the risks and benefits, exploring alternatives — including doing nothing — and then come to a conclusion. That’s the goal of the informed consent process, best known by the paperwork patients sign at the end saying they heard doctors describe what they may be getting into.

If only it were that simple.

Today’s article springboards off Cooney’s piece two weeks ago on heart stents, reported here by Dr. John Grohol as Doctors Say One Thing, Patients Hear Another.

A Boston non-profit, FIMDM is the force behind Gary Schwitzer’s excellent Health News Review service, which analyzes health news in the media, teaching e-patients and policy people to sift the gold from the garbage.


Posted in: pt/doc co-care | Why PM




7 Responses to “Informed Medical Decision-Making: the challenges of doctor-patient communication”

  1. Roger Heath says:

    This process is best handled by decision support software. Most patient encounters in the UK are handled this way. This references clinical data with full differential diagnosis, makes errors less probable, provides the patient with a complete and more accurate format of information. For references on this see:

    Roger Heath

  2. Informed consent is tricky for both patients and physicians. As a physician, it took me a long time to recognize the fact that what I see as a “statistical” conversation (likelihood of risk vs. likelihood of benefit vs. chance of complications, etc) is quite often seen by the patient as either a conversation (a starting point for them to learn more) *or* an all or none conclusion (if you don’t have the surgery you will [not might] die).

    The statistical conversation (in the mind of the physician) is like an equation. Feed the data in and the knowledgeable patient will dispense the (desired) answer. Unless of course there’s something wrong with their computational clinical skills. And of course, then it’s their problem.

    Unfortunately (or fortunately), the informed consent process is much more complicated than that. Part of what I think is required is to allow the patient time to process information in a way that is meaningful. Something which is difficult in the setting of a busy office with a waiting room full of patients. But, nevertheless, necessary.

    Something like decision support software is good. But the process (and timing) of how patients calculate and appreciate their own risks and benefits must be respected.

  3. BTW, thanks for the great posts and links. I really appreciate the continuing medical education!

  4. Howard Luks says:

    I had posted this a while back but thought it was relevant to the issue you brought up. This is a huge issue…from a patient care perspective as well as from a med mal perspective…thus docs shld be incentivized to improve communication skills and verify that information was properly processed.

  5. Martin Young says:

    At risk of earning Dave’s ire again, I’ve spent five years working on a solution to solving the problems of informed consent. I need to share it here as a potential solution to a problem you have raised.

    I have explored every aspect of the difficulty in taking consent, and I believe it is an impossible task to do the job properly without resort to technology. Doctors may do and say the right thing, but without documentation, a patient remembers only about 30% of the content of the discussion.

    Doctors also have to document the detail as well. For every patient the content differs, because some risks are higher or lower depending on the extent of the disease and the patient’s underlyng health. So standard handouts are not particularly useful.

    So we’ve designed a solution to take all that into consideration.

    Why is it so important?? I believe this – the way a doctor takes consent is a fine marker of quality. If patients deserve to be treated as consumers with the same rights, the consent process, i.e. document, can be a 100% transparent, shareable, confirmation of ethical high quality practice that is in the patient’s possession as well as in the medical record.

    This is ePatient nirvana. Bring this about – make it a prerequisite of medical practice and the standard of care will be raised automatically.

    Will doctors necessarily welcome this? For many I doubt it, because of the “What’s in it for me?” effect.

    What would be in it? Good evidence in malpractice claims for one. Secondly, one could predict different tiers of medical practice with better levels of payment, remuneration according to the standard of practice – rating doctors like hotels, perhaps – 1 star to 5 star. Reputation enhancement from happy patients etc, etc. The doctors already taking good consent would find technology to be very useful and timesaving. Doctors who do not would stand out by not taking advantage.

    Use of a system that documents consent to a high standard could be used as a tool to lower malpractice insurance premiums, passing those savings down to the patients, who at present pay for those premiums in high consultation fees.

    That’s the huge potential of getting this right. The argument that it is too difficult to do no longer stands – we have the web-based software to do it already.

    Where would the push to achieve attention to consent have to come from?? From patients – ePatients especially.

    You guys!!! Please forgive me if I’m passionate about this. I don’t see any other realistic way of changing the doctor-patient relationship in a manner that is this much of a win-win solution for all.

  6. […] event is organized by FIMDM,  about whom I wrote in September, saying “You can’t be well empowered if you hear advice wrong. That’s why, in […]

  7. […] so they can be more effectively engaged in their care. One aspect is shared decision making, which we wrote about in September. A related topic, from August, is understanding the challenges of pathology and […]

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