ICBioethics Blog 

Encouraging Shared Decision Making Cannot Come Down to Costs Alone

The facts are before us: not only is shared decision-making supported by the law and the right thing to do, it shows benefits. Evidence suggests shared decision-making helps patients address questions and fears and become more confident about their treatment choices. And I am guessing it leads to greater patient satisfaction . . . probably more significantly than better hospital menus.

This change in healthcare culture seems slow in coming. Why? Some suggest that the compensation system drives behavior by rewarding volume, and many doctors believe that engaging in shared decision-making with patients will take too much time. (How can the informed consent process have any validity without it?!) Still others assume they know patients’ preferences, although evidence exists to the contrary.

Culture changes can result from either internal pressure or external influences. Some states are exerting external pressure via a carrot-and-stick approach. Washington and others have passed laws granting greater medical-liability protection for organizations implementing shared decision-making practices.

In an environment often led by cost reduction, shared-decision making may show cost benefit, especially in unnecessary, elective surgeries; however, champions of shared decision making are quick to point out that shared decision-making does not necessarily mean cost reduction. But cutting costs is not the real purpose anyway. Patient/consumers expect (and laws support) doctors to offer them evidence-based medicine with ample opportunity to become fully informed – that is with the facts regarding both risk and benefits – in a way that they can understand – to assist them in making choices. They also expect to be heard, with their preferences acknowledged and respected.

Doctor-patient shared decision making needs to be promoted and encouraged both system-wide and at the individual facility level to reassure both doctors and their patients. Doctors need to see administrators acknowledge and support the extra time “lost” and be afforded sufficient time to accomplish this. Patients need to experience health care in an environment that says they are worth that time. And if this process becomes too lengthy, unreasonable, or unresolvable, an ethics consult should be called because it is overextending the doctor’s scope.

Cutting corners on doing the right thing can’t possibly save money in the long run, can it?

Mitch Gennuso