Shared Decision Making: Informed Consent v. Informed Choice

November 30, 2009 · Filed Under general · 5 Comments

This guest post, presenting the view point of Howard Luks ( @hjluks on Twitter). Howard is an orthopedic surgeon. He serves as the Chief of Sports Medicine, Arthroscopy and Knee Replacement at Westchester Medical Center, in Westchester County, NY. Asked about participatory medicine and patient engagement, Howard told me “I am infinitely intrigued by the possible uses for social media to improve the delivery, access and quality of health care to the patients I have the honor of treating everyday.” He raises a very important point about the variations among patients of their willingness to take charge and become engaged in their care.

I was so impressed by his blog post that I asked him for permission to republish his original post here.

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here’s what people more typically do after a diagnosis: Gather up a hodgepodge of information—online and by talking to friends—that is often incomplete, inaccurate, and incomprehensible. “Generally speaking, the perception of chances of good and bad outcomes is very poor,” says Annette O’Connor, a researcher at the University of Ottawa in Canada who has long studied how best to get patients informed. A patient may think a treatment is going to cure him when it might only lessen symptoms, for example, or that the risks are more serious than they actually are. The Foundation for Informed Medical Decision Making (www.informedmedicaldecisions.org), a nonprofit patient advocacy group that is supporting the 12 centers, cites research showing that most people can’t answer even basic questions about their illnesses. Often, they simply defer to their physician. But doctors rarely give comprehensive information. Time is short, they often have biases—surgery and rehab for that torn ligament beats trying rest, exercise, or physical therapy, say—and many assume patients don’t want the burden of overwhelming information.

via health.usnews.com

For now, the *standard* is Informed Consent. Basically your doctor tells you what is wrong, details the treatment recommendation and tells you the reasonably foreseeable risks, potential complications, etc. For decades, this has been the standard. The problem with this is that it does not take into account the variables introduced by each individual patient and their values.

Tags: Arthroscopy, Basic Questions, Biases, Foreseeable Risks, Hodgepodge, Important Point, Information Time, Informed Choice, Informed Consent, Knee Replacement, Luks, Medical Decision, O Connor, Orthopedic Surgeon, Patient Advocacy Group, Physical Therapy, Sports Medicine, Torn Ligament, Treatment Recommendation, Twitter, University Of Ottawa, Westchester County Ny, Westchester Medical Center