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Archived Comments for: Shared decision-making in Israel: status, barriers, and recommendations

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  1. Putting shared decision-making into context

    Michael Millenson, Health Quality Advisors LLC and Northwestern University

    29 March 2012

    The article by Talya Miron-Shatz and colleagues provides a valuable service in both surveying shared decision-making in Israel and internationally and in discussing the driving forces behind it. Harvey Fineberg's commentary is similarly interesting and informative.

    It is not suprising that it is easier for the patient's voice to be heard in an institutional setting -- on various committees -- than in the exam room in nations where health care funding overwhelming comes from the government. In that case, "patients" equals "voters," and everyone listens to the needs of the group whose support is critical to funding.

    I suggest that in the exam room we could learn from the model suggested by physicians and ethicists Quill and Brody back in 1996. They speak of an enhanced partnership informed by the medical evidence, the patient's preferences and values and the doctor's experience. (See their article on physician decisions and patient autonomy at: https://bitly.com/#)

    Second, the definition of patient-centeredness is expanding from its roots in ethics and the civil rights movement to include more well-defined economic and clinical components. This expansion and the justification for it can be seen in provisions of the Accountable Care Act (national health reform) in the United States. Those specifics can be useful to these authors and others interested in the topic. The white paper I recently co-authored for the Urban Institute on behalf of the Robert Wood Johnson Foundation on patient-centeredness and the ACA can be accessed here: http://bit.ly/y7VmdS.

    Part of that expansion, by the way, is to a more inclusive "participatory medicine." As a board member of the Society for Participatory Medicine, which includes both patients and clinicians, I would urge those interested in the "grassroots" on this topic to join (30 bucks a year) to be part of the listserv and to look at the journal (www.jopm.org)

    Finally, although this is an open access journal on the Internet, it is an Israeli journal. And so, I had one disappointment. Should there not be some mention of national culture in a nation where a belief in shared decision-making on EVERYTHING goes back to Abraham challenging G-d's decision on Sodom and Gomorrah? This is mishpachah, after all -- no need to hide what everyone knows! And, more seriously, cultural expectations, shared or not, among doctor and patient are an important part of the clinical interaction.

    Congratulations to all.

    Michael Millenson
    Highland Park, IL
    President, Health Quality Advisors LLC; The Mervin Shalowitz, MD Visiting Scholar, Kellogg School of Management, Northwestern University; and author, "Demanding Medical Excellence: Doctors and Accountability in the Information Age."

    Competing interests

    None

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