By Linda Girgis, MD
Editor in Chief, Physician’s Weekly
Marcus Welby is dead. In fact, he was never even a real doctor–rather, a fictional TV character–yet, many people hold up his example as the ideal doctors should aim to attain. He did it all: cared for his patients, was a good listener, and even did home visits. He may not have treated as many patients with as complex diseases as we do now, but people still pine for the doctor he theoretically was.
Although the idea of Marcus Welby may seem appealing in some senses, in other ways his way of practicing medicine appears completely out of line in the 21st Century. It is no longer acceptable for the doctor to be a paternalistic (why does no one ever say maternalistic?) caregiver who decides what’s best for his or her patients. Some patients still feel that the doctor knows best, and follow whatever their recommendation is, but increasingly, the doctor now gives the patient as much information as possible–from diagnostic tests or clinical experience–to help the patient make the best decision(s) regarding their own healthcare. Sometimes, the doctor needs to give their opinion as to the best option. Other times, the role of the doctor is to help the patient decide among equally beneficial options. At still other times, the patient rejects the advice of the doctor and chooses their own clinical path.
Patients can feel lost in this process: they need to understand why a decision (diagnostic test, prescribed medication, etc.) is being recommended, and feel that they can change their mind at any stage of their healthcare journey. How can we as healthcare professionals equip our patients to truly participate in medical decisions with us, and make good choices?
Secrets to improve shared decision making:
- Ask questions. Some of my patients ask many questions, while others don’t ask any. For those who are less inquisitive, I try to offer answers to concerns they may have. But, sometimes with the quiet ones, I’m still left feeling that they didn’t receive the best medical information. I tell all patients to speak up–healthcare professionals are allowed to ask questions too. If you feel like a patient hasn’t asked you for information they will need, ask them a question and let them show you if they are comfortable taking the conversation to where you believe it needs to go.
- Give patients trustworthy information and show them how to find more. We all need to beware of believing everything we read online, but there is a lot of good medical information available on the internet. We are better prepared to find the good resources and avoid the bad than patients. Get familiar with the resources your patients might need, so you can point your patients in the right direction and teach them what to look for to spot reliable information.
- Keep your eye out for interactive and live patient programs. You don’t have to be the only one responsible for answering questions; live programs give your patients an opportunity to ask questions between visits. These programs can support patient knowledge of their disease and communication with you. In a study conducted by PlatformQ Health, approximately 60% of patients and caregivers who participated in an interactive program about B-cell Non-Hodgkin’s Lymphoma experienced improved communication and collaboration with their provider after the program.
- Encourage patients to talk to others. Sometimes, experience is the best teacher. There are advocacy groups for most diseases, and these can offer a wealth of disease-specific information and resources. As a doctor, I can recommend the best medications for your diseases, but unless I experienced it myself, I can’t know what if feels like. Having the support of others can be quite curative in many instances.
As the healthcare system grows more and more complicated, patients must be their own advocates and shared decision makers in their health. We want them to have the best outcomes possible, and since we cannot make those choices for them, we need to support their growth and education.