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Beyond Shared Decision Making: An Expanded Typology of Medical Decisions

Author

Listed:
  • Simon N. Whitney

    (Department of Family and Community Medicine, Baylor College of Medicine, Houston Center for Education and Research on Therapeutics, Houston, TX, swhitney@bcm.edu)

  • Margaret Holmes-Rovner

    (Health Services Research, Michigan State University, Center for Ethics & Humanities in the Life Sciences, E. Lansing)

  • Howard Brody

    (Family Medicine, Institute for the Medical Humanities, University of Texas Medical Branch, Galveston)

  • Carl Schneider

    (University of Michigan Law School, Ann Arbor)

  • Laurence B. McCullough

    (Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX)

  • Robert J. Volk

    (Department of Family and Community Medicine, Baylor College of Medicine, Houston Center for Education and Research on Therapeutics, Houston, TX)

  • Amy L. McGuire

    (Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX)

Abstract

The most popular current models of medical decision making, identified by names such as shared decision making, informed decision making, and evidence-based patient choice, portray an empowered patient actively involved in his or her medical choices and generally assume that patient and physician reach agreement. These models are limited to a specific type of decision (in which there is more than one choice) and a specific process (in which agreement is reached). The authors extend the model of medical decision making beyond shared decisions in 2 dimensions. First, the authors incorporate a class of medical decisions in which there is only one medically reasonable treatment option, such as the removal of a primary melanoma. Patient preferences are irrelevant to whether or not the melanoma should be removed, so there is no treatment choice in which the patient can share. When there is only one realistic treatment option, the clinician's job is not to offer alternatives but to explain why there is only one viable choice and move the decision-making process forward. The physician does not thereby abridge the patient's autonomy; rather, the disease process itself constrains both patient and physician. Second, the authors include decisions in which patient and physician do not reach agreement. Sometimes the patient insists on a particular treatment and the physician reluctantly yields, sometimes it is the other way around, but disagreement is commonplace in clinical medicine and its presence deserves inclusion in the way we think about medical decisions. Conflict resolution requires acknowledging the potential for conflict.

Suggested Citation

  • Simon N. Whitney & Margaret Holmes-Rovner & Howard Brody & Carl Schneider & Laurence B. McCullough & Robert J. Volk & Amy L. McGuire, 2008. "Beyond Shared Decision Making: An Expanded Typology of Medical Decisions," Medical Decision Making, , vol. 28(5), pages 699-705, September.
  • Handle: RePEc:sae:medema:v:28:y:2008:i:5:p:699-705
    DOI: 10.1177/0272989X08318465
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
    2. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
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    Cited by:

    1. Alarape, A. A. & Adegboye M. O. & Ogunniran O. O & Omoba, F. A, 2021. "Health Information Resources and Clinical Core Skills as Predictors of Medical Doctors Clinical Decision Making in Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 5(6), pages 175-184, June.
    2. Mendick, Nicola & Young, Bridget & Holcombe, Christopher & Salmon, Peter, 2010. "The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives," Social Science & Medicine, Elsevier, vol. 70(12), pages 1904-1911, June.

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