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Research

Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6165 (Published 05 December 2016) Cite this as: BMJ 2016;355:i6165

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Re: Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial

This research is certainly welcome; it brings to mind the critique of Michel Foucault. So often knowledge is kept within our hands as doctors, leaving patients bereft of both knowledge and the power of what should happen next, a rather vulnerable position to be in, only augmented by what can be a terrifying experience lying prone in an emergency department, petrified that the pain might be a heart attack. This study reclaims both knowledge and power for the patient.

The main caveat is the study's applicability for socialised forms of healthcare. Are paying patients more likely to avoid hospital admission? Would a patient receiving care in Germany, Switzerland, UK et al, be more likely to stay in hospital-precisely because the cost is not borne directly?

Additionally, as per Foucault, Power's "success is proportional to its ability to hide its own mechanisms." Perhaps these decision aids are just another means of imposing our will, in the hope of avoiding litigation?

Competing interests: No competing interests

11 December 2016
Michael B Blank
Doctor, Peterborough City Hospital
Cambridge