Shared decision making still needs to be informed by evidence-based medicine

http://www.ncbi.nlm.nih.gov/pubmed/23226628

Indian J Endocrinol Metab. 2012 Nov;16(6):871-2. doi: 10.4103/2230-8210.102979.

Patient-centered care in diabetology: From eminence-based, to evidence-based, to end user-based medicine.

Kalra S, Megallaa MH, Jawad F.

Source

Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, India

"Many of us initially learnt eminence-based medicine, which gradually gave way to evidence-based medicine (EBM). Did physicians, who shouldered all responsibility for patient wellbeing during the earlier era, then abdicate their duties to clinical trialists and statisticians? Or did their work increase, as they now had to ensure that eminence was concordant with evidence? Similarly, as we move from EBM to end-user based medicine or PCC, will our responsibility decline? Or will we have to meet enhanced expectations, as we work to augment diabetes literacy and numeracy in our patients, improve their communication skills, and ensure that they participate with equipoise in shared decision making (SDM)? Will we have to work harder, or work hardly, if we deal with patients empowered in the real sense of the word?

Do patients have a right to choose targets and outcomes, and make clinical decisions? Almost always, the patient does make the final decision. The doctor, at best, can suggest the best possible course of action, during a few-minute long consultation, but it is the patient who walks the talk."