Shared Decision Making
in Family Medicine
Introduction to Primary Care:
a course of the Center of Post Graduate Studies in FM
PO Box 27121 – Riyadh 11417
Tel: 4912326 – Fax: 4970847
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Our experiences as patients: did
you ever feel powerless?
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Objectives
• At the end of this session the participants will
be able to;
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discuss the definition of patient empowerment
discuss the status of patient empowerment in FP
explain the need for patient empowerment
explain the power/relationship graph
discuss the reasons of powerless patients
explain how to empower patients
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What is it?
• an individual being an active member of
his/her disease management team
Laura E. Santurri. Patient Empowerment: Improving the Outcomes of Chronic Diseases Through
Self-Management Education. http://www.case.edu/med/epidbio/mphp439/Patient_Empowerment.htm 4 / 18
The idea behind
• Patients cannot be forced to follow a
lifestyle dictated by others.
• Preventive medicine requires patient
empowerment for it to be effective.
• Patients as consumers have the right to
make their own choices and the ability to
act on them
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Why Patient Empowerment?
Remember the “patient centered clinical method”
• Evaluating both the disease and the illness experience
• Understanding the whole person
• Finding common ground with the patient about the
problem and its management
• Incorporating prevention and health promotion
• Enhancing the doctor-patient relationship
• Being realistic
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Why Patient Empowerment?
• Only 9% of consultations with surgeons and primary care
physicians meet full criteria for informed decision making.
Braddock JAMA 1999
• Distinguishing elements of shared decision making occurred in
0-11% of audio taped patient interviews with general
practitioners.
Elwyn 2001
• “.. Checking of understanding, and the involving of patients in
decision making .. are rarely demonstrated” [in video taped
consultations submitted for MRCGP examination].
Campion BMJ 2002
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Why Patient Empowerment?
“People whose lives are affected
by a decision must be a part of
the process of arriving at that
decision.”
–John Naisbitt, Megatrends
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The Power/Relationship Graph
Keep
Power
Share
Relationship
Transaction
Partnership
http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck
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Problem Solving
Keep
Impose
Dictate
Compromise
Common ground
Power
Share
Relationship
Transaction
Partnership
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Countries
Keep
USA
China
Power
UK
Italy
Share
Japan
France
Russia
Germany
Sweden
Middle east
Relationship
Transaction
Partnership
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Why is the concentration of power in
this relationship with physician?
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Education
Professional status/authority
Knowledge
Skills
Expertise
Experience
On familiar territory
GATEKEEPER TO HEALTHCARE SYSTEM
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Why is the concentration of power in this
relationship with physician?
• Patient is sick, weak, vulnerable, not feeling fully
oneself…
• Patient may be afraid
• Patient in a state of dependency
• Lack of medical knowledge
• Lack of knowledge on the “system” and how it
works
• Unfamiliar environment
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Benefits of Patient Empowerment
• Learning from our patients
• Taking a proactive role
• Providing a support & information service
to our patients and staff
• Complaint Resolution
• Negotiation & Mediation
• Building trust
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Presenting concern
“patient’s story”
Model for
Clinical Problem Solving & ISDM
DOCTOR - PATIENT
COMMUNICATION
Hypothesis
Step 1
Establish pt’s role in
decision making
Identify
choices
History and
physical exam
Identified
problem or
diagnosis
Management
/ treatment
Follow-up
Review pt’s preference
for information
Step 4
Present
evidence
Respond to pt’s ideas,
concerns and expectations
re: management
Assess partnership (review previous steps)
Negotiate a decision
Step 7
Agree on an action plan
Step 8
Step 2
Step 3
Step 5
Step 6
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*ISDM: Informed Shared Decision Making
Disempowered
Not involved
No dialogue
No Voice in the System
Feeling vulnerable
No Partnership
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Some useful hints before finishing
• The skilled family physician can spend 10 minute with a patient
and the patient feels it was 20 minutes
• Even the busiest physician can accomplish wonders in a few
minutes by indicating that their full attention is on the patient
• Please conclude every interview with the statement “is their
anything else bothering you that we have not discussed?”
• Rather than assuming that the patient have understood the
instructions, ask them to repeat as they understood
• Use the patients name or ask him what he prefer to be called as
• Use “how can I help you? Rather than “what brings you here
today?”
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Empowerment allows our relationships to grow in strength
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