Shannon Brownlee (author of the excellent Overtreated) writes that spending the time with patients to undergo shared decision making can help reduce unneeded medical therapy:

It turns out that when patients have access to decision aids, and they share the decision with their doctor (usually their primary care doctor), they are less inclined to undergo invasive procedures than patients who learn about treatments in the usual way ““ often during a hurried conversation with an overworked physician. Sometimes patients are a lot more reluctant to undergo tests and procedures once they really understand the tradeoffs. For some surgeries, patients who have access to shared decision making are 60 percent less likely to choose the surgical option.

Sounds good in theory, but can it be applied to the real life? It’s doubtful.

First off, are decision aids readily available for the thousands of available diagnostic and therapeutic procedures? If so, please tell me where they are. Having them easily assessable to physicians would be a good place to start.

Next, shared decision making takes time, which the current payment system does not pay for. Without financial incentives, it doesn’t get done. Harsh, but true.

Finally, does the legal community accept shared decisions should the medical outcome go awry? Dan Merenstein did everything Brownlee suggested, and we all know how he was rewarded for his efforts.