Objective: Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling... Show moreObjective: Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training.Discussion: Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all rele-vant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only super-ficially involving patients.Conclusions: We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM. Show less
Low-value care is increasingly recognized as a global problem that places strain on healthcare systems and has no quick fix. Verkerk et al. have identified key factors promoting low-value care on a... Show moreLow-value care is increasingly recognized as a global problem that places strain on healthcare systems and has no quick fix. Verkerk et al. have identified key factors promoting low-value care on a national level, proposed strategies to address these and create a healthcare system facilitating delivery of high-value care. In this commentary, we reflect on the results of Verkerk et al. and argue that uncertainty has a crucial role when it comes to reducing low value care. This uncertainty is reflected in lack of a shared view between stakeholders, with clear criteria and thresholds on what constitutes low-value care, and a cross-cutting theme related to the key factors identified. We suggest to work on such a shared view of low-value care and different from implementation efforts to explicitly address uncertainty and its driving cognitive biases grounded in human decision making psychology, to reduce low-value care. Show less
Objective: To investigate physicians' preferred and usual roles in decision making in medical consultations, and their perception of shared decision making (SDM).Methods: A cross-sectional survey... Show moreObjective: To investigate physicians' preferred and usual roles in decision making in medical consultations, and their perception of shared decision making (SDM).Methods: A cross-sectional survey of 785 physicians in a large Dutch general teaching hospital was undertaken in June 2018, assessing their preferred and usual decision making roles (Control Preference Scale), and their view on SDM key components (SDMQ9 questionnaire).Results: Most physicians (n = 232, 58%) preferred SDM, but more often performed paternalistic decision making (n = 121, 31%) in daily practice than they preferred (n = 80, 20%, p < 0.0001), most commonly because they judged the patient to be incapable of participating in decision making. Most physicians preferring SDM presented different options for treatment (n = 213, 92%) with their advantages and disadvantages (n = 209, 90%) but fewer made clear that a decision had to be made (n = 104, 45%) or explored the patient's wish how to be involved in decision making (n = 80, 34%).Conclusion: Although most physicians prefer SDM, they often revert to a paternalistic approach and tend to limit SDM to discussing treatment options.Practice implication: Teaching physicians in SDM should include raising awareness about discussing the decision process itself and help physicians to counter their tendency to revert to paternalistic decision making in daily practice. (c) 2019 Elsevier B.V. All rights reserved. Show less
