Shared Decision Making – What is it?

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell and today our guest is Dr. Jay Lee, a board-certified Family Medicine physician at MemorialCare Medical Group's Primary Care office in Long Beach. Dr. Lee believes that the doctor-patient relationship is based on teamwork, open communication and mutual respect. Today we'll be talking a little bit about shared decision making. Welcome, Dr. Lee.

Jay Lee, MD: Hello.

Deborah Howell (Host): Maybe we could start with a definition. What exactly is shared decision making?

Jay Lee, MD: Well, shared decision making gets at the heart of the relationship between the physician and the patient, and I think in the old model of healthcare delivery, the doctor was the holder of information and kind of helped the patient make decisions. But nowadays, I think patients have been a lot more empowered to have information, bring it with it, share it with the doctor. But also the doctors really need to work towards changing their role in terms of not only helping to coach a patient with regards to information, but being understanding that the patient has autonomy and the ability to make decisions for themselves.

Deborah Howell (Host): I guess you're saying the outdated "doctor is God" is a little outmoded at this point.

Jay Lee, MD: That is correct. We live in a modern world. That is correct.

Deborah Howell (Host): Although, you know, we still look to you for your wise counsel. I mean, you're the ones that have put in the experience and you've been to med school, you know what's going on, you're on the cutting edge of things. What we do is sometimes we Google way too much information and get ourselves in trouble.

Jay Lee, MD: Yeah, and our role really then is to coach our patients so that they understand what information is evidence-based versus just written on the internet. And it allows for us to have kind of a broader dialogue around how do we best achieve each individual patient's health and well-being goals.

Deborah Howell (Host): I think anyone who has inputs into any situation has a little bit more peace of mind, rather than just being, you know, a sort of didactic situation.

Jay Lee, MD: Yeah, and I think the didactic model is one that I think the evidence shows that it's not as effective as when you have a patient that's engaged with the decision-making process. Just like, you know, when you're making a decision and someone else is imposing that upon you, a lot of times, I think as an individual, you're not really as thrilled about that as if you had come up with the idea yourself or were involved in that process. And I think that really gets at the heart of why shared decision making is a growing and important part of the way we deliver care today.

Deborah Howell (Host): As you were saying that, I was picturing a 14-year-old kid, you know, rebelling against somebody that said, "You must do this," or a 55-year-old man who's maybe a little bit overweight saying, "You must eat this." That really doesn't work, does it?

Jay Lee, MD: No, and, you know, there's a saying that when you start to apply that type of advice to a patient, their eyes glaze over, right? It's a situation where you've just kind of lost that moment to really affect somebody's health because they're checked out.

Deborah Howell (Host): Okay. Now, when you're a patient, your family and your physician are making a shared decision, what should be considered?

Jay Lee, MD: Well, I think a variety of things. So, first of all, I would say what evidence is there to support one decision over another? And doctors still are required obviously to read quite a bit, and there's a ton of literature that comes out and it's hard to organize that. And so, part of that is relying on your doctor to be up to date on what the latest evidence is for a treatment or a diagnostic test. Once that information has been considered and we know what evidence there is to support decision A versus decision B, then it really comes down to goals and preference, flavored with that information. So, for example, there's a patient that comes in and they've got, say, borderline high blood sugar, and any day now they could become a diabetic. So, a lot of the times we talk about, well, this is what the blood test shows. These are some treatments that could be applied in this situation. And usually, you know, it's: Do we start a low-dose medication if it looks like you're going to become a diabetic, or do we really focus in on lifestyle changes like diet and exercise? And then I talk to the patient about, you know, how motivated are they? Are they on a scale of 1 to 10, are they a 10, or are they a 4? And if they're not very motivated, I ask them, "Well, how do you think you could... what would it take for you to be more motivated?" They might tell me a story about, "Well, I've got kids and I'm really worried about the future for my kids and I want to make sure that I'm here for them." Then that's something I can work with, right? And we can couch the decision around their kids and the desire to sort of be here and to be healthy. On the other hand, if they don't feel very confident and they're not very motivated and they just said, you know, "I'm not going to push them to try to make those lifestyle changes," and then we might say, "Well, why don't we talk about starting a medication and then rechecking in a few months." So that just gives you a little glimpse into how that decision making happens for some of the day-to-day routine medical decision making in the office. And then of course, this can be applied to larger decisions, you know, life or death decisions, decisions about cancer care, etc. And that's where the primary care doctor plays a big role, I think, in helping to coach patients to make the right decision for them.

Deborah Howell (Host): It's all very logical. I mean, if you have some skin in the game, as they say, you're more likely to succeed. What are some of the benefits of shared decision making?

Jay Lee, MD: Well, I think I alluded to some of them earlier in the sense that it really allows for patients to feel much more a part of the process in terms of making those decisions. I think the end benefit in that is that the plan that's laid out is more likely to be successful for the patient. That can make the patient happy, it can also make the doctor happy, because that's a large part of doctor happiness, is when patients are able to achieve their goals and are able to be healthy and to optimize their health. And so, I think there are benefits both for the doctor as well as the patients. And the truth is, also for families that are involved in the care. They hear everything out in the open. It's a much more transparent process than, "Well, my doctor just made me do this." You know, they talk about the reasons for why that decision was made.

Deborah Howell (Host): Make your doctor part of your team, but also get yourself involved, get your family involved, make these decisions together. And I think there's a large, large success rate when this happens.

Jay Lee, MD: Yes.

Deborah Howell (Host): Now, if our listeners would like more information on shared decision making, where can they go?

Jay Lee, MD: Well, there are two websites that I can recommend. One is informedmedicaldecisions.org and the other is familiesusa.org.

Deborah Howell (Host): Very easy. I'm going to give that again. Inform- what was it?

Jay Lee, MD: informedmedicaldecisions.org.

Deborah Howell (Host): Okay.

Jay Lee, MD: And familiesusa.org.

Deborah Howell (Host): Got it. Well, thank you so, so much, Dr. Lee. It's been great to have you on the program today to talk to us about shared decision making. Next time you go to the doctor, put him on your team and just make the best decision available to your family. Thank you so much. To listen to the podcast or for more information, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.