18 September 2012

Evidence Based Shared Decision Making: Building patient relationships

 I remember a while back I went to the doctor, the first visit with this physician at a walk in, and when they found out I was a Medical Librarian I was given an uninvited and not-so-polite spiel about Evidence Based Medicine (EBM).  In particular it was the term that was eating away at this person who staunchly claimed that it implied that's not what they've been doing all along!  Where I agree this could be a misconception I think it's important to understand EBM as a group of thought, a practice ethos with a coined name vs. a jab at clinical expertise and experience. In reality there needs to be a healthy dose of both.  One of the glaring pitfalls of 'too much EBM'  is that what may be proven in a study may not in fact be what's best for a particular patient with a particular issue at a particular time and place in their life.  In other words it may not be individualized enough:  enter clinical expertise/experience and something called Shared Decision Making.  It seems a straight forward concept but often times may be overlooked whether it be lack of time or honing skills for information translation to a patient audience.

"Image courtesy of [basketman] / FreeDigitalPhotos.net"


Shared Decision Making (SDM) allows patients and providers to build a relationship whereby the patient is informed and empowered with options to take control of their health.  Physician expertise and EBM work together to inform the patient's choices but ensures it's an individualized decision based on the patient's needs not just the physician's experience and evidence.  What may be best for one patient may not be considered best for another.  The Informed Medical Decisions Foundation website details much more about Shared Decision Making and includes some quick provider tools to help guide the process.

To help your patients along without reinventing the wheel try these excellent decision aids compiled from across the web by the Ottawa Hospital Research Institute and each given clear ratings by the International Patient Decision Aid Standards (IPDAS)

To be fair, by the end of my visit to this doc, despite the tirade, I felt like I was given information and options: in fact this physician was actually very much practicing what I would consider to be EBM and SDM!  Maybe it was their eventual consideration to the meat and potatoes of my profession but I appreciated the transparency and candor of what the latest research was and how that affected my options for care. In fact I appreciated it so much and found it to be such a rare approach that despite the rocky start I left the office only after they agreed to take me as a permanent patient!