Dr. Joseph Sirven: Shared Decision-Making

Published: Friday, October 28, 2016 - 10:41am
Updated: Friday, October 28, 2016 - 10:45am
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Dr. Joseph Sirven
Dr. Joseph Sirven

Shared decision-making is a new buzzword in medicine. Medical commentator, Dr. Joseph Sirven explains.


I woke up one day with excruciating pain over my left flank and knew something was very wrong. This led to an emergency room visit accompanied by my wife and son with what turned out to be a kidney stone. In the ER I was given two options for treatment: a 20 percent chance that this stone might  pass, so simply go home and hydrate or, the other option, get admitted and basically have an operation in order to break the stone apart. My son looked at me “Dad, don’t be ridiculous- get the operation." Yet, I only processed the word 20 percent success and assumed that I would be the winner in the kidney stone lottery, as my pain was controlled in the ER. I made my choice and went home.

My story is an example of a modern healthcare management concept, shared decision-making. This buzzword codified in the Affordable Care Act is a way of improving quality and cutting costs and requires both patient and doctor to share all decisions, holding both accountable. Shared decision-making should lead to a conversation where the patient understands their condition and the clinical evidence to make value-based decisions along with the doctor.

Fast forward twelve hours, it's one in the morning, I’m back in the ER with my family and I’m begging for that operation. At that moment, I appreciated my healthcare team because they had abided with my earlier decision even when I was gently reminded during my initial visits that 20 percent success means 80 percent failure. Yet here they were in the dead of night, graciously and professionally taking care of me with no mention of my earlier choice.

Shared decision-making is complicated, as doctors must honor preferences even if the patient is delaying the inevitable and not saving any healthcare costs. Both doctor and patient are on the hook for each and every decision and, in hindsight, common sense doesn’t always prevail. I agree that shared decision making is the way we need to go, but sometimes you need an extra voice at that table like my son who admonished me to not be “ridiculous."  Well, sadly, I was and my body held me accountable.

Dr. Joseph Sirven is the chairman of neurology at the Mayo Clinic.

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