A new project at UBC aims to bring doctors and patients together to take a
shared role in making decisions about medical care.
Called Informed Shared Decision Making, the project will train
physician-patient teaching teams and create educational packages on
communication skills, critical evaluation of research evidence and decision
making for physicians, patients and undergraduate medical students.
Research shows that patients who take a more active role and have more
information about their illness, respond better to treatment which may result
in less demand on scarce health care dollars.
“Patients need to be informed, and physicians need to know how to help their
patients become informed,” said project head William Godolphin, a professor in
the Dept. of Pathology and Laboratory Medicine.
Godolphin said the project is a reflection of several trends: greater interest
in health promotion, people taking more responsibility for their own health
care, and a changing environment for doctors in which the traditional,
paternalistic model of medicine is giving way to a more consumer-oriented
Most complaints made against physicians–80 per cent of those heard by the
College of Physicians and Surgeons–arise from a lack of communication, he
Physicians often think they give more information than they actually do, and
patients often do not know the right questions to ask.
In part, this stems from the physician-oriented communications skills taught in
medical schools, such as how to break bad news or obtain useful information
from reticent patients.
“What we are talking about is a higher range of communications skills:
decision-making aids, assessment of risk, giving patients access to information
and helping them assess it by making it more meaningful to them,” Godolphin
He gave the example of a male patient suffering from mild hypertension. His
doctor could prescribe medication that helps some patients, but not all,
decrease their chances of suffering a stroke. However, some treatments carry a
risk of impotence.
“That kind of question ought to involve a patient’s choice, his feelings about
risk-taking and what things in life are valuable to him. It ought not to be
only the physician’s values that determine what the treatment will be.”
The project will teach physicians how to assess patients’ cultural, social,
economic circumstances and their willingness to take risks, help patients to
weigh the evidence of risks and benefits in relation to their values, and how
to then work in partnership to reach a decision about what should be done.
As well, the project team is involving patients, advocacy and community groups,
patient associations and agencies involved in patient education.
“The patient can be a powerful agent for change of physician’s behavior,”
Based in the Office of the Co-ordinator of Health Sciences, Division of
Educational Support and Development, the project is currently funded by grants
from the B.C. Medical Services Foundation, administered by the Vancouver
Foundation, and UBC’s Teaching and Learning Enhancement Fund.