Overworked physicians struggle to involve patients in medical care decisions, study says

Increasing patient involvement in medical care decision-making is a worthy objective, but a new study reveals that physicians may be spread too thin to make that goal a reality.

Medicare has challenged doctors to implement more shared decision-making to make medical care more patient-centered, reports the new study from Rand Corp. But researchers say overworked physicians have a difficult time making that happen, need more instruction on how to engage patients, and require better information systems to make sure patients know their options and receive individualized care.

“Even primary care practices that received extra resources to implement shared decision-making ran into sizeable real-world obstacles,” says Mark W. Friedberg, MD, MPP, the study’s lead author and a natural scientist at Rand. “Currently, the healthcare system works against providers who want to make patients full partners in the medical decision-making process. Giving patients truly personalized care will require a long-term commitment to redesigning the system.”

The study analyzed eight primary care practices participating in a 3-year initiative intended to increase shared decision-making and was funded by the nonprofit Informed Medical Decisions Foundation.

The full results are published in Health Affairs, but the overall consensus was that using other office staff instead of overworked physicians to help distribute materials for making medical decisions, and addressing electronic health record (EHR) deficiencies, could help increase the rate of shared decision making. Doctors participating in the study said that their EHR systems lacked the ability to store patient-reported values and preferences.

“Despite its importance, shared decision-making is still infrequent in American medicine,” Friedberg adds. “Introducing shared decision-making won’t be easy, but we found that providers who have plans for overcoming the barriers will have the best chances of success.”

“With financial incentives encouraging shared decision-making, provider organizations will invest in needed staff, tools, and infrastructure, and providers will focus on improving their shared decision-making skills,” continues Richard Wexler, MD, a study co-author and chief medical officer at the Informed Medical Decisions Foundation.

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