Making Sense of Medicine: Bridging the Gap Between Doctor Guidelines and Patient Preferences
  • New Book: Making Sense of Medicine
  • Advance Praise
  • About Zack Berger
  • Talking To Your Doctor
    • Talking To Your Doctor: Buy the Book >
      • Praise and Critique
      • Talking to Your Doctor: Resources and Questions for Discussion
      • Excerpt
  • Blog
  • Past Events
  • Sholem's Bias: Medicine and Other Curiosities (A Podcast)

Dismissing preferences?

10/8/2013

1 Comment

 
Picture
At the International Conference on Communication in Healthcare, which I just returned from, there was a discussion continuously coursing beneath the surface and bubbling up every once in a while. If we - acolytes of shared decision making, whether patients or providers - want to encourage decision making that has the person involved at the center, recognizing their preferences and values, does the kind of decision in question have anything to do with the relevance of those preferences? Is it really the case that (as was said multiple times during the conference) there is "no such thing" as preference-sensitive decisions, for the reason that all decisions are sensitive to preferences? Everything - it was said in this argument - involves preferences, and countless decisions are made in the course of a day. Getting into the car to go to the doctor's office is a decision. Taking a pill, or not, is a decision. Picking up the phone to talk to someone about your symptoms: that's a decision too. So, the argument goes, to pick certain health care decisions as more "preference sensitive" than others is meaningless. Everything involves an exercise of wants, desires, and priorities.

I think this ignores the diverse uses of the term "decision" and the verb "decide." Surely not all of the following are the same?

I decided to take an aspirin to reduce my chance of heart disease.
I decided to go to the doctor.
I decided to take a deep breath.
I decided to perform CPR on this bystander in the street.
I decided to forgo resuscitation if my heart should stop.
I decided to quit smoking.

It must be that these involve various shadings of the word decision, a different mix of voluntary, quasi-voluntary, outwardly imposed, and preference-sensitive action. If we are to further care that is consonant with peoples' preferences, we should recognize that sometimes these preference are at the fore in a given decision ("I decided to walk 2 miles every week!") and sometimes not ("I decided to take time off work to take care of my mother"). There are differences that should be recognized, and eliding them runs the risk of dismissing when preferences might actually be most important.


1 Comment
Richard R. pesce, MD
10/8/2013 03:27:55 am

Certainly the nuances of the used word needs to be taken account of. The framing of the word use is important. Sometimes a rose is not always a rose, but this understanding presupposes we know about the person making the statement. As far a preferences during a health care issue is concerned, it appears that the narrative of the patient is of utmost importance and this is what we as clinicians must pay attention to this in order to sort through the nuanced meaning of the active verb use.

Reply



Leave a Reply.

    Author

    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.

    Archives

    March 2017
    January 2017
    December 2016
    November 2016
    October 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    November 2015
    October 2015
    August 2015
    July 2015
    June 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013

    Categories

    All

    RSS Feed

Powered by Create your own unique website with customizable templates.