Shared Decision-Making: Partnering With Your Clinician Greg Simon Group Health Cooperative, Seattle, WA Chair, DBSA Scientific Advisory Board

Outline What is shared decision-making How providers think Before a visit After a visit Questions to ask about any medication (or other treatment) Handling conflicts Sharing your experience with peers Your turn

Shared Decision-Making means: Traditional view: Providers make decisions. At times, they should invite consumers to participate. Reality: Consumers make decisions all the time – about treatment and about more important things. But providers think they make decisions. Maybe we should clue them in.

What are the decisions? (Consumer’s view)

What are the decisions? (Doctor’s view)

Who knows about what: Providers know about averages: Expected benefits of treatments Possible risks and side effects. Consumers know about experience and values: How have treatments affected me – both good and bad. What matters most to me.

How do providers think? Always behind – and feeling guilty because of it Want too much to be liked – so may avoid conflict or difficult issues Accustomed to being in charge (or at least thinking that they are) Worried that any problem will be their fault Looking for patterns (and sometimes jumping to conclusions)

Before a medication management visit? What are my most important questions or goals for this visit? What (if any) changes did we make at our last visit? What effects (good and bad) have I noticed since then? What else is happening in my life that my doctor should know about? On a separate page: medication details (dose, schedule, side effects)

Before a therapy visit? What are my most important questions or goals for this visit? What plan did we make at our last visit? What about that plan has worked? And what hasn’t? What else is happening in my life that my therapist should know about?

Starting off a visit What are your goals or questions? What is your provider’s agenda? What will you have time for?

Finishing up a medication management visit Review complete medication plan (get it in writing) What (if any) change are we making? What are we hoping that change will do? When and how will we judge whether that change is a good idea? What problems should I watch for? When should I come back (or call)? Anything else that either of us is supposed to do before our next visit?

Finishing up a therapy visit What should I be trying to do differently now? How and when will we evaluate that plan? When should I come back?

Why keep a mood chart? Help you and your clinician to track how you’re doing Help to clarify when treatment is helping (or isn’t) See connections between mood symptoms and changes in your life Help to see things from a distance

Questions about any medication (or other treatment)? BENEFITS What is this treatment supposed to do? What has it done for me? How and when will we evaluate that – or re-evaluate it?

Questions about any medication (or other treatment)? RISKS OR SIDE EFFECTS What are the possible side effects or risks? What side effects or problems have I seen? How will I tell if this is not safe for me?

We might not agree because: We’re starting with different assumptions We’re seeing different facts We’re applying different priorities or values

Suggestions for disagreeing effectively Speak up early Be specific Assume good intentions Offer an alternative (if you have one) Leave room for a graceful way out

Your experience matters, so share it! We tell our friends and neighbors about schools, hairstylists, and dentists. But most of us don’t announce our experience with psychiatrists or psychotherapists. Now you can

Your turn – role play