Best Facebook Question of the Month Award goes to Deborah Steinig of Baltimore, Md., who writes:
"So, Zack, often you speak about doctors and patients making decisions together, abandoning the patriarchal model, not having doctors assume that they know best, etc. Are vaccines at an extreme of rightness/necessity/medical clarity where you would forego shared decision-making (because in your mind there is no real question) and strongly urge a patient to get a vaccine? Or do you go through the shared-decision making process anyway because that's the best way to win the trust of a vaccine-cautious parent and get to yes? Do you feel differently about, say, flu vaccine than MMR?"
I will quote my patient. He asked me, "Should I get the flu shot?" and I said unhesitatingly, "Yes." "Then I'll get it!" he said. "You're always so wishy-washy, but when you say to DO something, I know you mean it."
The implied insult (or backhanded compliment) aside, your question has two answers. One is - Of course I frame the vaccine decision differently than other decisions. From a behavioral psychology perspective (you're supposed to call it behavioral economics these days), everything gets framed a certain way - no presentation should or can be unbiased. So, while I carefully steer the patient between the shoals of over and undertreatment for mammograms, for example, I tend to hammer home my pro-vaccinism when it comes to that point. (And I do frame vaccines against infectious disease, or cancer prevention [e.g. HPV vaccine], differently than zoster vaccine, which I consider solidly grounded in evidence but optional.)
The other answer is: yes, EVERYTHNG is part of shared decision making. The strongest ethical case for SDM is NOT that it makes us healthier or happier, or that it leads to less overuse, but that it grows out of a fundamental respect for people and their decisions. Even when they are stupid. No, ESPECIALLY when they are stupid. Human beings, when viewed as ends and not means, are allowed to be autonomous. My role as a provider is to enable that autonomy.
This conflicts, of course, with my role as a public health agent. Therein hangs a tale. (And perhaps a voyage on the highways and byways of Kant, if I ever understood him.) Or perhaps a book chapter.
The author of Talking To Your Doctor and Making Sense of Medicine blogs about the books, shared decision making, doctor-patient communication, and the redeemable imperfections of healthcare.