From shared decision making to patient-centered decision making

This is a commentary on http://www.ijhpr.org/content/1/1/5/ webciteIn an illuminating paper on the status of shared decision making in Israel, Talya Miron-Shatz and her colleagues review the legal protections of patient rights and dignity in clinical encounters, the requirements for lay participation in the formulation of certain health policies, and the state of education and research on the principles and practice of shared decision-making in Israel [1]. The article covers some special circumstances, such as end of life care, and examines the barriers to more widespread adoption of shared decision making, including attitudes of ambivalence on the part of physicians and patients.The authors favor shared decision making because greater patient involvement represents higher ethical standards and because of practical advantages of improved adherence to treatment, greater satisfaction on the part of patients, and, occasionally, superior health outcomes. The paper points out that shared decision making has gained in popularity in many countries and argues that the education of health professionals should be geared toward preparing them to practice in ways that directly involve patients in their care decisions. The legislative and research infrastructure to facilitate shared decision making are currently in place in Israel, the authors argue, and Israel's universal coverage and relatively small number of health plans establish a foundation for more widespread reliance on shared decision making.The concept of shared decision making impinges on many aspects of health care and policy, from informed consent for surgical procedures to public hearings on policy proposals. In this brief commentary, I offer a perspective on shared decision making in the clinical relationship between doctors and patients. I believe that an ideal approach to shared decision making would be more flexible than the authors of the paper present and, where appropriate, more systematic and explicit in c