“We know clinician–patient exchanges become more interactive when clinicians ask open questions and allow silence, so that patients are encouraged to provide their views [rather than just saying yes or no],” Dr. Pieterse says. “A key characteristic of this encounter is for the physician to be curious about this individual patient and motivated to learn more about this patient’s situation, needs and desires.”
Some clinicians and rheumatologists may question the value of re-evaluating the schedule and format of patient encounters to encourage more effective decision making and connection. Often, clinicians say there is no time for involving patients in decision making, but Dr. Pieterse asks what is it for which there is too little time? Only if rheumatologists have insight into when time is lacking and for what it is lacking will they be able to create time that will effectively involve the patient, she says.
“Rheumatologists need to become clear on the situations and cases in which they would really want the patient to be involved, and then find out when time is too short and when time can be saved,” Dr. Pieterse says.
This approach doesn’t mean a rheumatologist’s workload should be transferred to the patient, she notes. Example: Some practices have patients prepare for a visit by reading information ahead of time, so the clinician does not need to explain it. This approach may be helpful, but may not be a patient-centered approach.
Dr. Pieterse says, “Understanding the situations in which more or less time is needed with clinical encounters means physicians and their patients work to understand how time could be better distributed over the decision-making process.”
Carina Stanton is a freelance science journalist based in Denver.
References
- Bomhof-Roordink H, Fischer MJ, van Duijn-Bakker N, et al. Shared decision making in oncology: A model based on patients’, healthcare professionals’ and researchers’ views. Psychooncology. 2019 Jan;28(1):139–146. Epub 2018 Nov 8.
- Pieterse AH, Stiggelbout AM, Montori VM. Shared decision making and the importance of time. JAMA. 2019 Apr 19.
- Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014 March;94(3):291–309.
- Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision making in clinical practice: Update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008 Dec;73(3):526–535.
