Shared medical decisions can provide comfort

Learning that you have a serious medical condition can be scary. If you have multiple treatment options available for your diagnosis, you may feel overwhelmed both by information and by fear of making the wrong treatment choice.

Part of my responsibility as a physician is to help patients make decisions about health care that give them the best outcome, make them comfortable and account for what they feel is most important.

For example, many patients are concerned about using medication to lower their high blood pressure. When I first talk with a patient about this, I discuss the healthy goal for the measurement of blood pressure compared to the measurements that person is seeing, the risks of uncontrolled high blood pressure (including heart attack, stroke and kidney damage) and the personal risks for these problems related to family history, cholesterol and other factors.

We also review what else this person can do to lower blood pressure: weight loss, a healthy diet and exercise. Most times, but not always, we agree that a combination of lifestyle changes and medication is best.

Once someone has decided to go ahead with blood pressure medication, we also discuss medication options (diuretics, calcium channel blockers, beta blockers, etc.), possible side effects, and costs and benefits of each medication for that individual.

This is an example of shared decision making, and in cases like this, we will revisit the choice periodically to make sure the medication is working well. We can also talk about changing to another medication if there are significant side effects.

All decisions about our health and health care are important, but some decisions are more permanent (like whether to have a lumpectomy or a full mastectomy for breast cancer) and can require more time and thought for quite a bit more information.

Shared decision making helps you and your doctor take into account what is important to you. Getting better and reducing risks of health problems are usually at the top of everyone’s list, but these need to be balanced with how a patient thinks he or she can deal with side effects that may or may not be permanent, invasive procedures, risks of possible complications and the amount of time possibly necessary for recovery.

There can be a lot of information to absorb in the limited time frame of an office visit. That is why shared decision making aids have been and are being developed for many conditions and to help with preventive health care choices like prostate cancer screening.

Decision aids present treatment options along with their advantages and disadvantages in understandable terms. They can also help you think about which treatment most closely aligns with your preferences and values.

Decision aids may be in the form of DVDs, online videos, booklets, worksheets or a combination of these formats.

Your health plan or health care provider may have shared decision aids available. Be sure to ask. If they do not, the Foundation for Informed Medical Decision Making (www.informed medicaldecisions.org/patient_ decision_aids.html) has shared decision aids on many topics that you can request.

Find links to patient decision aids and worksheets both for specific conditions and for general health decisions from the Ottawa Hospital Research Institute (http://decisionaid.ohri.ca/index.html).

The Center for Shared Decision Making (http://patients.dartmouth- hitchcock.org/shared_decision_ making.html) has a decision aid library that has links to many Web-based decision aids.

Sometimes, especially for more serious issues, you may find you want your health care provider to make the final decision on treatment. That is fine, and it is OK to say so if that is how you feel.

If you find yourself in that situation, do your best to communicate important things about your life, your values and anything else you can think of that will assist your health care provider in selecting a treatment most suited to you.

Your body is yours to take care of and to make decisions about in all aspects of your health care. Ask questions about preventive medical care and acute and chronic diseases and get all the details you need.

Your health care provider can help you know what is happening with your body, give you information and point you in the direction of more materials that you can review. Then together you can make shared decisions that are right for you.