In routine office medicine most physicians do not encounter a frequent need for the informed consent process unless their practice is heavily focused on procedures, such as the practice of a surgeon or a gastroenterologist. Yet almost all physicians and their patients frequently engage in dialogues which require the patient to make decisions regarding their care. These decisions may involve acquiescence to a relatively straightforward treatment regimen (think tetanus shot for a puncture wound) or they may entail a complex decision set surrounding a medication which offers potential serious side effects as well as its benefits (think Procrit, for example).

To address appropriate decision-making on the part of the patient, communication studies have searched for an effective approach which will reach the patient, while not requiring too much time or other resources on the part of the clinician. Shared decisions and informed decision-making are two techniques which have been found to be most effective. Finding a way to use these techniques to their best effect can improve the quality of your relationship with your patients and the quality of the care you give while simultaneously reducing your liability. Finding a way to use them without greatly stretching time and ability is the challenge which has turned some physicians away from a concerted approach to these processes. This article will review these processes in an attempt to help you effectively move your practice in this direction without instituting radical changes.

Much of the publicized research on shared or informed decision-making focuses on very serious decisions such as determining what type of cancer treatment to choose.

Your practice, however, may seem more mundane. It is appropriate to review the difference between shared decisions and informed decisions so that they can be put in the context of the interactions you have with your patients.

Shared decision-making is defined by the U. S. Preventive Services Task Force (USPSTF) as a process involving the clinician and the patient “in which the patient:

û        Understands the risk or seriousness of the disease or condition to be prevented

û        Understands the preventive service, including the risks, benefits, alternatives, and uncertainties

û        Has weighted his or her values regarding the potential benefits and harms associated with the service

û        Has engaged in decision making at a level at which he or she desires and feels comfortable

This process has the goal of an informed and joint decision.”

The task force also describes informed decision-making as the “individual’s overall process of gathering relevant health information from both his or her clinician and from other clinical and non clinical sources, with or without independent clarification of values.” [1]

As you review these descriptions you may see that you already have informed decision and shared decision conversations with patients during at least some of their visits; these conversations may not be conducted in detail every time they transpire but they do happen. You undoubtedly run into some barriers too. Certainly, there are some patients who show less inclination to be informed; and you encounter different levels of patient comprehension of the material you share with them. It is likely that you encounter time constraints which require you to shorten these conversations more than you may wish; and you may find it difficult to explain some of the intricacies of available choices to your patients in a manner which they would understand. Yet clear communication with your patients is of value to them and to you.