Shared Decision-Making

Abstract

S hared decision-making (SDM) between physician andpatient is an idea founded in ethics and the law and in some evidence of superior health outcomes.SDM is the practical reconciliation of respect for persons (autonomy) and the monopoly and power of physicians: a middle ground between "nanny-knows-best" paternalism and rampant consumerism.SDM includes the notion of a medical encounter as a "meeting of experts" -the physician as an expert in medicine and the patient as expert in his or her own life, values and circumstances (Tuckett et al. 1985).The doc prescribes but the patient takes the pills (or doesn't).Trends in healthcare policy emphasize involvement of community and service users in many aspects of their care.Indeed, the popular enthusiasm of governments for self-care initiatives cannot be imagined without such involvement.However, authentic involvement surely requires participation in decision-making. SDM and Patient SafetyThe relevance of SDM to patient safety has been highlighted by at least three important concepts.First, major reports and publications about patient safety, such as the Bristol Inquiry (Bristol Royal Infirmary Inquiry 2001) and To Err Is Human (Institute of Medicine 2000), have produced important and relevant responses (Department of Health 2002; Institute of Medicine 2003).These responses have insisted on patient involvement in decision-making and training of health professionals for "new rules" for 21st-century healthcare that make the patient the "source of control."Put simply, a key component of patient-centred care is shared and informed decision making.Second, prescribing errors and (lack of ) adherence to medicines