Intended for healthcare professionals


Engaging patients in medical decision making

BMJ 2001; 323 doi: (Published 15 September 2001) Cite this as: BMJ 2001;323:584

The end is worthwhile, but the means need to be more practical

  1. Richard L Kravitz, professor and director,
  2. Joy Melnikow, associate professor
  1. U C Davis Center for Health Services Research in Primary Care, Sacramento, California 95817, USA

    The growing consensus that patients ought to be more involved in their own care lies at the confluence of several powerful ideas. Political trends, thinking on ethics, and research on health services have all contributed. As experienced consumers, patients understand that they have rights, and they are much less inclined than they used to be to leave medical decisions entirely to the experts. Ethicists have by and large accepted the principle that autonomy (what the competent, informed patient wants) trumps beneficence (what the doctor thinks best for the patient) in all but the most extreme circumstances.1 In addition, there is evidence that the expanding involvement of patients in care produces better health outcomes, providing an empirical rationale for what may have been an inevitable shift in power and social control.2

    A supplement to this September's issue of Quality in Health Care focuses on engaging patients in medical decisions. Twelve articles, derived from a Medical Research Council conference, cover the meaning, mutability, and measurement of patients' preferences regarding treatment. The proceedings leave the clear …

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