Patients' desires for participation in decision making vary

Although the case for a listening doctor who is open to the ideas of patients in the history taking part of the consultation is strong, there is little good evidence that patients want to be involved in deciding on their management. McKinstry (p 867) showed video vignettes of consultation scenarios in which patients were or were not involved in deciding their management to 410 patients attending surgeries in Lothian. Many preferred consultations in which the doctor took the major part in decisions about management, especially for physical conditions. For lifestyle and psychiatric problems, however, more chose scenarios where patients were involved in management decisions. Preference for involvement was associated with higher social class and education and younger age group. Associations were far from absolute, suggesting that doctors need both communication skills and time in consultations, along with knowledge of their patients, to determine at which times, with which illnesses, and at what level their patients want to be involved in decision making.

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Relevant Article

Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes

Brian McKinstry
BMJ 2000 321: 867-871. [Abstract] [Full Text] [PDF]