Intended for healthcare professionals


A key medical decision maker: the patient

BMJ 2001; 323 doi: (Published 01 September 2001) Cite this as: BMJ 2001;323:466

New decision making aids should help patients make the decisions

  1. Richard A Deyo, professor of medicine (
  1. Center for Cost and Outcomes Research, Department of Medicine, 146 N Canal Street, University of Washington, Seattle, WA 98103-8652, USA

    Primary care pp 490, 493

    Many medical decisions fall into a grey area where the optimal choice for an individual patient may be unclear and where reasonable people might choose differently. Common examples include elective surgical procedures, such as lumbar discectomy or resection for benign prostatic hypertrophy. Drug treatment may pose similar choices when treatment offers both appreciable benefits and appreciable risks. Hormone replacement therapy in postmenopausal women is an example, as is anticoagulant therapy in patients with non-valvular atrial fibrillation. Decisions about such treatments are made daily in clinical practice, and there is considerable evidence that patients want more information and greater involvement in them. In general we do a poor job of providing information, though this week's BMJ includes studies of two examples of a new generation of interactive methods of patient information that holds promise of improvement. 1 2

    Decision aids are more than handouts

    Although physicians often describe the nature of decisions to their patients, they less often discuss risks and benefits and rarely assess patient understanding.3 Though invasive procedures require “informed consent,” it usually takes the form of seeking patient agreement with a recommendation, rather than quantifying the risks and benefits …

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