“You are the doctor. Why don’t you just tell me what to do?”
“If this were your child, what would you do?”
“I did not go to medical school, how can I make this decision?”
These are phrases physicians often hear from families and patients not comfortable actively participating, or not knowing that they can be active participants, in their health care decisions.
On the opposite end of the spectrum, there are patients who research online and meet their physician with a printout in hand having decided on a specific treatment plan. As medical information becomes increasingly available on the internet, a growing number of patients are interested in sharing medical decision-making with their physicians.
The goal of shared decision-making is for the physician and patient to come to a mutual understanding about the patient’s preferred treatment option(s). But it is not always safe to make medical decisions by committee. For instance, if a child has a limb or life threatening infection, a doctor’s decision to treat must be fast and decisive. If a broken leg is crooked and deformed, the decision to reduce or realign is clear.
At other times, medical decisions have pros and cons that require weighing the risks with the benefits. Controversial, or “grey area” topics, make the practice of medicine both a science and an art. For instance, not every 13 year old with a torn anterior cruciate ligament (ACL) is best served with surgery. A family and patient must consider the desire to return to cutting and pivoting sports, the ability to participate in physical therapy, and the impact on a family’s socioeconomic resources.
As surgeons, our jobs do not begin and end in the operating room.
There is a patient attached to the injured knee, a family attached to the patient, and a school and or job(s) attached to the family. I am grateful to be confident in my technical skills as a surgeon with good outcomes and low complication rates. I also am grateful that patients acknowledge my ability to communicate with them in a compassionate way. Some of my colleagues may supplement their practice with a physician extender (e.g., nurse, physician’s assistant, or medical assistant) to help shepherd the decision-making process.
Second opinions are also an important tool in the shared decision-making process. Patients should be encouraged to seek other opinions and make sure that their physician is a good fit for them. This should not be confused with “doctor shopping.”, as too many cooks in the kitchen can create confusion and interfere with continuity of care.
Choices are important but can be overwhelming. Be sure to understand your care options: if there is a clear recommendation from your doctor or more than one choice for you to consider as a team in your care. Understand your responsibilities as a patient in the shared decision-making process. Better outcomes can be when a patient is informed and involved.
Patient responsibilities when making shared decision with your doctor:
- Remember that your orthopaedic surgeon has the benefit of extensive training and knowledge, but many decisions may require your input.
- Prepare any questions in advance and bring them in writing to be sure you have them all addressed. If you are confused about your care options, ask questions.
- Take notes and ask for handouts or website recommendations for additional information.
- Know the preferred way to reach your doctor or their physician extender.
- Understand the timeline of recovery, how much this may vary, and who needs to be on your recovery team.
- Seek another opinion if necessary, but consider limiting your opinions so as not to get confused.
- When possible, bring a family member or friend to your visit to help listen and ask questions.