One of the modern forms of mutual doctor-patient collaboration is so-called 'shared decision-making'. This type of mutual relationship has a relatively short history. It began to be written about in the 1980s. In this trend, the doctor-patient relationship is based on increasing the patient's medical knowledge and having more influence on treatment decisions. Both patient and doctor share information and insights about treatment options. Decisions are made jointly based on both people agreeing on a course of action. This doctor-patient relationship requires a lot of effort on both sides, but also offers new therapeutic possibilities.
For the doctor, the 'shared decision-making' model can give a great deal of information about the patient's previous experience of treatment and their individual preferences for further treatment. It also provides an opportunity to find out what the patient's expectations are and what their belief system is in relation to health, their illness and what they would like their treatment to look like. It can give information about what is important to the patient and what their expectations are, what needs to be respected in their value system. If the doctor does not have this information, he may give arbitrary decisions that the person being treated will not accept. This can then end in the patient not buying the prescription, stopping the medication or not coming to the next appointment.
Joint discussion and decision-making can therefore be a much more effective way of guiding treatment than unilateral decision-making. If the doctor unilaterally decides, this may not be accepted by the patient. If the patient unilaterally decides, he may not be able to fully assess his condition. He or she may lack knowledge about the treatment and may make irrational decisions. The model of agreement and shared decision-making in many cases can be very beneficial for both the patient and the doctor.
However, a relationship based on 'shared decision-making' requires a longer conversation between the doctor and the patient. Both people have to present their opinions and discuss them in the course of it.
This model cannot be used when the patient does not recognise that he or she is ill and does not see the need for treatment. Shared decision-making is possible if both parties are willing to agree on each other's opinions and the way forward. If one of the parties does not see the need to agree on anything, for example they want 100% of their opinion to be accepted, then there can be no agreement on a decision. This is sometimes the case if the patient is in a state of psychosis, does not recognise his symptoms and the need for treatment. Then the doctor or the patient's relatives are often forced to make decisions for the benefit of the person.
What can help is to arrange their relationship on the basis of "shared decision-making":
- you need to have some knowledge about your illness and how to treat it
- to extend this knowledge when new circumstances arise
- respect the doctor's opinion (this does not mean unconditionally agreeing to everything, but listening and being willing to understand his opinion)
- ask for further clarification if you need it
- you need to be able to talk about your beliefs and views about your condition and your expectations about treatment
- talking, exchanging opinions and agreeing on further treatment is of paramount importance
- you should make your objections and concerns clear during the visit
- if you do not accept the doctor's recommendation, you should say so during the appointment, and not act in your own way afterwards
- if, after discussion with the doctor, a decision is reached jointly, you have to take responsibility for its implementation.
Article taken from Issue 4 of Finding the Way
