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Shared Medical Appointments and Shared Decision-Making

Which treatment should I use?  Does it matter which drug I take?  Do I need surgery?

Medical decision-making is never easy.  It is never devoid of emotion and completely rational.  And it is rarely done in a silo.

Lately, there has been a push for shared decision-making among doctors, patients, and families.  Shared medical appointments and shared decision making go together like peanut butter and jelly.  Milk and cookies.  Or, since we are in healthcare, like peas and carrots.

A 2011 article written by two of our own – Deb Prescott and Zeev Neuwirth – pointed out that shared medical appointments create “a highly empowering dynamic that fosters tremendous engagement on the part of the patients and their family members”.  Deb and Zeev point out that the shared medical appointments create “a real-time face-to-face social network as medical care is being delivered.”

This social network, which consists of the providers and patients alike, naturally creates an environment in which decisions are made with the support of the physician and group.  Not only is the healthcare team answering questions, but so are other patients that have experienced similar situations.  Patients can bring their spouse, parent, child, best friend - any caregiver, really - to a shared medical appointment so that they are hearing the information first hand as well.  This encourages shared decision making and open communication, which in turn enables patients to make a more informed, more holistically analyzed health decision.

Here are how some organizations are using shared medical appointments to aid in shared decision making:

Palo Alto

One of the Palo Alto Medical Foundation’s (PAMF) initiatives is Partners in Medical Decision Making (PMDM), a program designed to study the implementation of decision aids (DAs) in primary care and to try to understand how these decision aids impact the health of their patients.  As part of this PMDM, Palo Alto has a series of three rotating SMAs.  These SMAs focus on the health concerns of geriatric patients, and the goal is to empower the patients to improve their quality of life. 

Dartmouth Hitchcock Medical Center

Dartmouth Hitchcock also offers both Decision Aids and Shared Medical Appointments, though they are not directly tied.  Dartmouth Hitchcock offers shared medical appointments in:

  • Dermatology
  • Internal Medicine
  • General Surgery
  • Neurology
  • Obstetrics
  • Orthopaedics
  • Pediatrics
  • Plastic Surgery
  • Rheumatology

They also have a Center for Shared Decision Making, where they offer counseling sessions, a Decision Aid library, and a Healthcare Decision Guide. 

United States Department of Veterans Affairs

The VA has a shared decision making program to help people with long term care.  It includes decision aids, a worksheet, and a self-assessment that patients and caregivers can use to make decision about long term care.  Like the organizations above, the VA has long been using shared medical appointments as a care option.