The Most Important Thing You’re Not Discussing With Your Doctor


Published:

© ILO/Thierry Falise, Flickr CC

Politicians and policymakers are discussing what parts of the Affordable Care Act to change and what to keep. While most of us have little control over those discussions, there is one health care topic that we can control: what we talk about with our doctor.

The Institute of Medicine (IOM) released the landmark publication Crossing the Quality Chasm 15 years ago. The report proposed six aims for improvement in the U.S. health system, identifying that health care should be patient-centered, safe, effective, timely, efficient and equitable.

The idea that health care should be patient-centered sounds obvious, but what does that mean? The IOM defines it as care that is “respectful of and responsive to individual patient preferences, needs, and values” and that ensures “patient values guide all clinical decisions.”

For this to truly happen, doctors’ appointments need to cover more topics than how one is feeling and what can be done. Does your doctor know your values?

If you answered no, you’re not alone. Fewer than half of people report that their physician or other health care provider asks about their goals and concerns for their health and health care.

Your doctor can discuss medical tests and treatments without knowing your life goals, but sharing your values and needs with your doctor makes discussions and decisions more personalized – and may lead to better health.

How Does Patient-centered Care Happen?

In order for your health care to center around you, your doctor needs to know your values, preferences and needs. Everyone is different. Your values and needs may also vary from one appointment to the next.

As a neurologist, when I’m working with a 76-year-old widow whose main goal is to remain independent in her home, we frame her care in that context. We weigh benefits of medications versus the complexity of adding one more drug to her crowded pill box. We discuss how a walker helps her be more independent rather than less, as she can move around her home more safely.

When a stressed college student comes to my office for a bothersome tremor, his preference is to avoid medications that he might forget to take or that might harm his school performance. This guides our discussion of the pros and cons of different options, including using medications but also doing nothing, an option that almost half of patients feel strongly should always be discussed. A year from now after graduation, we’ll revisit the conversation, as his goals and needs may be different.

In sharing their values and goals with me, these individuals enabled a health care approach that respected their needs and also responded to their life circumstances.

Values And Shared Decision-making

Incorporating your values alongside what we know from medical research is the basis of shared decision-making, described as the pinnacle of patient centered care. Shared decision-making is a partnership between you and your physician. If you involve someone else like a spouse in decision-making, they can be engaged in shared decision-making, too.

Shared decision-making is not just relevant when deciding whether or not to start a treatment, but also when deciding whether to undergo screening (e.g., mammography) or get testing to tease out a diagnosis. The key element of shared decision-making is incorporating your values and preferences alongside the best available evidence.

To do this, your physician should explain the medical information associated with each of the different options – the research, the anticipated benefits and how likely they are, the risks and how often complications or side effects happen, the costs, etc.

Your physician should also discuss your values and preferences as they relate to these options. For example, when partnering with a person with chronic daily headache and a high-stress job, I’ll help him or her reflect on the potential benefits of fewer headaches on work productivity but also the potential impact of the side effect of morning grogginess.

With so many options and so much uncertainty in medicine, individualized care is critical. That happens most effectively if you and your doctor are on the same page about your goals and needs.

Tools For Navigating Shared Decision-making

There are three-step and five-step outlines for shared decision-making, which are primarily aimed at helping physicians be intentional about this process.

These models frame the steps of medical discussions slightly differently, but both emphasize that patients and health care professionals need to be engaged – it’s a partnership. Alternatives are compared, values discussed and a decision made. Reassessment is also an important part of shared decision-making, as alternatives and values can change over time.

For common decisions, different health care organizations have created decision aids to help physicians and patients talk through the scientific evidence, pros and cons, and values that are likely to impact the specific decisions to be made.

The Agency for Healthcare Research and Quality has decision aids on topics including lung cancer screening, nonsurgical treatment options for women with incontinence and treatments for men with localized prostate cancer.

The Mayo Clinic Shared Decision Making National Resource Center has decision aids for common topics such as choosing the right medicine for depression and deciding whether you should treat osteoporosis (and if so, what treatment makes the most sense).

Decision aids are not designed for patients to make decisions on their own. They are created to enhance your partnership with your doctor, providing a structured way for you to talk through a decision by reviewing the evidence and your preferences.

What You Can Do

While busy lives can hinder introspection, it is helpful for you to know your own goals and needs. Are you focused on working two more years until retirement? Do you want to explore physical therapy or diet changes before considering medications? Are you walking your daughter down the wedding aisle in two months and want something to hide the tremor that never really bothered you before?

If you know your values and your goals for the coming months or years, it’s easier to share them with your doctor.

Shared decision-making also requires you to be an active participant. Listen to the options, the pros and cons. Ask questions. Think through how each option relates to your personal values and preferences. Take time if you need it. And then with your doctor, decide what’s best for you.

Melissa J. Armstrong is a neurologist who specializes in movement disorders and cognitive impairment, particularly Lewy body dementia. She also serves as an evidence-based medicine consultant on healthcare guidelines and investigates strategies relating to patient and carepartner engagement in clinical care, research, and guidelines.

This article was republished from The Conversation.

See also:
Integrative Medicine: The New Model For Primary Care
Power Up: Be In Charge Of Your Life And Health

Edit Module
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags

Daily Astrology

April 22, 2018

Happy Earth Day!!! Let’s all celebrate our one true home! The Moon is in the fertile sign of Cancer, ideal for planting flowers, vegetables and trees and offering thanks to Mother Earth. A sweet, easy lunar sextile to Venus gets the morning started with…
Edit ModuleShow Tags

Alternative Health Directory

Browse all listings »

Edit ModuleShow Tags
Edit ModuleShow Tags

Calendar

April 2018

Usui Holy Fire II Reiki I Prerequisite: a desire to learn Reiki Study includes the history of Reiki, the Reiki principles, the hand positions used to give Reiki to yourself and to others,...

Cost: $175 (pre-registration required)

Where:
The Studio at One Earth
191 Emery Mills Road
Shapleigh, ME  04076
View map »


Sponsor: The Studio at One Earth
Telephone: 207-636-2500
Contact Name: The Studio at One Earth
Website »

More information

Have you done yoga before but feel a little rusty? Haven't been on your mat in a while? Yoga Basics is a great place to begin again. Do you feel you need motivation to jump-start your...

Cost: $60

Where:
YogaLife Institute of NH
6 Chestnut Street
Lower Level
Exeter, NH  03833
View map »


Sponsor: YogaLife Institute of NH
Telephone: 603-969-8968
Contact Name: Brian Serven
Website »

More information

Show More...
Show Less...

This workshop is part of the At the Heart of the Matter: a series of workshops about all things HEART. How do we connect with our hearts? And what keeps us from staying connected? In this...

Cost: $35

Where:
Newtonville, MA


Telephone: 617-913-0683
Website »

More information

Show More...
Show Less...

Feel the bliss of opening your spine, while being totally supported and meticulously aligned. Great for sciatica and low back pain! Classes also held Saturday mornings.

Cost: $18 drop in

Where:
Bliss Through Yoga
484 Bedford St
East Bridgewater, MA  02333
View map »


Sponsor: Bliss Through Yoga
Telephone: 508-331-3564
Contact Name: Janice
Website »

More information

Show More...
Show Less...

As springtime rolls around, many of us get out our trash bags, buckets, and boxes in order to clean out and tidy up our homes and offices. Physically cleaning our spaces is great and all, but did...

Cost: Free

Where:
WeWork
31 St. James Ave
Boston, MA  02116
View map »


Sponsor: The Kabbalah Center
Website »

More information

Ayurvedic practitioner. Presenting a 28-day program designed to initiate and maximize detoxification and nourishment of your body, mind and soul, inspiring results that can last a lifetime. For...

Where:
Concord, MA


Website »

More information

Show More...
Show Less...

This workshop is part of the At the Heart of the Matter: a series of workshops about all things HEART. What does it mean to be deeply touched inside? To feel something deeply? To be connected?...

Cost: $35

Where:
Newtonville, MA


Telephone: 617-913-0683
Website »

More information

Join Mediums Laura Wooster and Andrew Dee for an evening of mediumship! In addition to sharing how you also can become more aware of your connection to passed loved ones, Laura and Andrew will...

Cost: $40

Where:
Circles of Wisdom
90 Main Street
Andover, MA  01835
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

YogaLife studio would like to offer this opportunity to slow it down, step back, notice your breath and sit quietly in community. Join us Thursdays from 5:40-6:30 PM. No Yoga...

Cost: Free

Where:
YogaLife Institute
6 Chestnut Street
Suite A
Exeter, MA  03833
View map »


Telephone: 603-969-8968
Website »

More information

Show More...
Show Less...

Ann Barker will be seeing clients on Friday, April 27th and Saturday, April 28th at Balance Bethlehem. Call to book your appointment today! This non-invasive screening utilizes a thermal...

Cost: Varies

Where:
Balance Bethlehem
2087 Main Street
Bethlehem, NH  03574
View map »


Sponsor: Ann Barker
Telephone: 603-897-9645
Website »

More information

Friday, April 27 - Sunday, April 29, 2018 April Ropes and Ritu Kapur Sohum’s 3rd Annual Retreat will be offered in Beautiful Berkshires, The Spirit Fire Meditative Retreat Center in...

Cost: $385

Where:
Spirit Fire Retreat Center
407 W. Leyden Road
Leyden, MA  01337
View map »


Sponsor: www.SOHUM.org
Telephone: 508-329-3338
Contact Name: Ritu Kapur
Website »

More information

April 27 - 29, 2018 What if there were 5 love languages in the bedroom…and you had a secret decoder ring? Imagine the erotic satisfaction you could unlock…for yourself and for...

Cost: $1097*/couple; Early bird $997* by Feb 14, 2018

Where:
Angel’s Rest Retreat Center
63 North County Road
Leyden, MA  01301
View map »


Sponsor: Conscious Intimacy
Telephone: 415-244-1652
Contact Name: Brynn Bishop
Website »

More information

Show More...
Show Less...

Ann Barker will be seeing clients on Friday, April 27th and Saturday, April 28th at Balance Bethlehem. Call to book your appointment today! This non-invasive screening utilizes a thermal...

Cost: Varies

Where:
Balance Bethlehem
2087 Main Street
Bethlehem, NH  03574
View map »


Sponsor: Ann Barker
Telephone: 603-897-9645
Website »

More information

India Discovery Center is pleased to announce the next seminar in the “Let us explore the Cultural History of India.” The fourth event entitled “Seminar on the Golden Period,...

Cost: $20

Where:
Bemis Hall
15 Bedford Road
Lincoln, MA  01773
View map »


Sponsor: India Discovery Center
Telephone: 781-259-0029
Contact Name: Bijoy Misra
Website »

More information

World Qigong Taichi Day is celebrated globally, and at Eastover, it is a day of free presentations, demonstrations and mini-classes offered by nationally recognized leaders in Taichi, Qigong,...

Cost: Free

Where:
Eastover Estate & Retreat Center
430 East Street
Lenox, MA  01240
View map »


Sponsor: Eastover Estate & Retreat Center
Telephone: 866-264-5139
Contact Name: Yingxing Wang
Website »

More information

April 28 - 29, 2018 Led by Marconics Teacher Practitioners:  Josh Brotherton and Nadine Muhammad To register:  From US:  Tel: 774-987-9449 Email: yourhealinglight@gmail.com...

Cost: $450

Where:
Suffield Massage Therapy and Wellness Center
230 Mountain Rd
Suffield, CT  06078
View map »


Sponsor: Marconics
Telephone: 774-987-9449
Contact Name: Josh Brotherton
Website »

More information

With award winning author Nancy Smith. Starts April 28th, 7-month certification program about Akashic records. One Saturday a month, 10am - 4pm. womenofwisdominc.com

Cost: $860

Where:
Women of Wisdom
North Easton, MA


Telephone: 508-230-3860
Website »

More information

Be a part of healing history! The last saturday of April each year in hundreds of cities, spanning over 80 nations, people come together…to breath together and provide a healing vision...

Cost: Free

Where:
Elm Park
Russell St
Worcester, MA  01609
View map »


Sponsor: Kung Fu & Tai Chi Academy of New England
Telephone: (774) 321-6611
Contact Name: Sifu Gary
Website »

More information

2018 Eclectic-Fest! Our fourth event that is building community, celebrating all spiritual beliefs and practice. Free parking and free admission. Featuring aura photography by the...

Cost: Free admission

Where:
Taunton V.F.W.
82 Ingell Street
Taunton, MA  02780


Sponsor: The Enchanted Forest Taunton
Telephone: 774-208-6195
Contact Name: Brother Granite
Website »

More information

Show More...
Show Less...
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags