Shared Decision-Making towards a Higher Quality of Care: Is This the Norm?

Abstract

Patient-doctor relationship has traditionally been paternalistic, in which the doctor decided on behalf of the patient. It focused mainly between the patient who called for help and the doctor whose decisions had to be silently observed and followed by the patient. In this paternalistic model, the physician used his skills to choose the necessary interventions and treatments that were likely to restore the health of the patient. All the information given to the patient was selected to encourage them to consent to the doctor’s decisions. This definition of the asymmetric or unbalanced interaction between physicians and patients has begun to be questioned over the last 20 years. There has been a shift from this direction to one where the patient is more informed, empowered, and independent - a move from a “paternalistic” to a more “complementary” relationship. Critics suggested a more active, autonomous patient-centered role which supports greater patient control, reduced doctors’ dominance, and a more mutual participation. This approach has been described as one where the doctor attempts to enter the patient’s world to see the disease with the eyes of the patient and is becoming the predominant model in clinical practice today.

How informed is informed consent?—Evaluating the quality of informed consent among surgical patients in a tertiary care hospital in Nepal

“…Although 68.6% of the patients agreed that they were given an opportunity to ask questions, it is a matter of great discussion if the patient’s autonomy was really safeguarded. The concept of decision-making in health care has changed from a paternalistic view (where healthcare providers dictate to patients what to do by assessing what is best for them) to shared decision-making (the active participation of patients in decision-making) [ 16 ]. The reason for the low number of patients knowing about the alternative option may be due to the persistence of such a paternalistic view of decision-making, as shown by AlHaqwi et al [ 17 ].…”