Report Finds Domineering Australian Doctors Are Making The Decisions For Patients

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Australia seriously lags behind the rest of the world on shared decision making between doctors and patients, according to a study reported in the Medical Journal of Australia.

The authors found most consultations are dominated by a doctor’s assertions and not by patient input.

Associate Professor Tammy Hoffmann from Bond University and coauthors said shared decision making, a “consultation process where a clinician and patient jointly participate in making a health decision”, was an international hallmark of good clinical practice.

The authors argued there were misconceptions about the shared decision-making process hampering its implementation in Australia.

The most frequently reported was that shared decision making would lengthen the duration of each consultation.

“Three systematic reviews … indicate that there is no systematic increase in consultation duration when shared decision making is implemented or decision aids are used,” the authors say.

Other misconceptions:

  • Patients would be unsupported when making health care decisions
  • Not every patient wants to share in the process
  • Most people are not able to participate
  • It cannot be used by vulnerable people
  • Clinicians already do it
  • Engaging patients will increase their anxiety.

The authors recommend five questions clinicians could use to guide them through the process: What will happen if we wait and watch? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice?

Limited training options, a lack of up-to-date high-quality evidence, lack of access to decision support tools and a lack of research to guide implementation of shared decision making for Indigenous and vulnerable populations were all barriers to widespread implementation in Australia.

“Australia is drastically lagging behind many other countries in all aspects of shared decision making — policies, lobbying, advocacy, research funding, training, resources and implementation,” the authors write.

“In the absence of a coordinated national effort, we encourage individual clinicians to begin incorporating shared decision making into their consultations with patients when a health decision is needed.”

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