Shared decision-making gained traction in the 1980s and remains the preferred model for health care interactions to this day. It emerged from the abandonment of strong medical paternalism, prompting scholars to explore alternative models of the patient-provider relationship that emphasize patient choice. The 1970s saw a growing emphasis on patient-centered care and a recognition of patient autonomy in healthcare. Patient autonomy encompasses several key considerations: self-determination, informed consent, respect for values, and freedom from coercion. It refers to the principle that patients have the right to make informed decisions about their own medical care. The term "shared decision-making" was used as early as 1972 by Robert Veatch and then gained popularity and traction after it appeared in the 1982 President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.
Patient autonomy promotes patient empowerment and engagement in their health care, respects patients’ dignity and individuality, enhances satisfaction and adherence to treatment plans we discuss during our patient visits, and can reduce medical and legal conflicts. The autonomy model is founded on the assumption that if given adequate information, a patient will be capable of making an informed decision consistent with their sense of well-being. This is an autonomous choice, free from controlling interference. This is true even when a patient's decision conflicts with a health care provider's recommendation. Although there is a consensus that patients should participate in and ultimately make their own medical decisions whenever possible, most versions of shared decision making assume that the health care provider has access to the necessary knowledge, understanding, and medical resources. How do we handle the complicated patient scenarios when a patient refuses medications or procedures we know can help?
Unmediated access to medical information and to an increasing array of health-related products and services has radically altered the balance of power between the health care provider and patient. But while patients can research their symptoms and look at a photo of their dermatologic condition online, they will continue to depend on their dermatology NP and PAs for advice, procedural expertise, and access to restricted medical services. By appreciating how the internet, social media, and other factors are transforming medical relationships, dermatology NPs and PAs will be better able to meet their patients’ health care needs in the age of enhanced patient autonomy, which the patient previously lacked.
Sources:
JAMA. 2018 Nov 20;320(19):1973–1974. doi: 10.1001/jama.2018.14382
Virtual Mentor. 2009;11(8):567-570
https://doi.org/10.1378/chest.11-0516
Justin Love, MPAS, PA-C, resides in the blue zone of Loma Linda, CA. He works for the Loma Linda University Department of Dermatology. In his spare time, he enjoys any ocean-related activities and spending time with his family.