This might surprise some patients, but a recent study found that most surgeons prefer to team up with patients to make treatment choices. Yet, surgeons tend to decide themselves instead. The study unearthed some clues as to why they do so and where to intervene to foster shared decision-making.
Almost 300 surgeons from 60 countries answered questions about whether they, patients, or the two together should make decisions and who typically made them when they saw patients. They also gave basic data about themselves and took a test of their ability to understand and use statistical information. They need number skills to help patients understand the possible risks and benefits of treatment.
Wishes versus reality
Almost 6 in 10 surgeons said they prefer to partner with patients to make treatment decisions. In contrast, 26 percent felt they alone should decide, with or without giving patients a say. A minority wanted patients to decide, perhaps after hearing the surgeons’ thoughts.
As anyone who has tried to beat a bad habit knows, what people do often differs from what they say. Despite most surgeons’ druthers for shared decision-making, only 36 percent typically decided with patients. Over half decided themselves. Few routinely let patients choose.
In fact, half of the surgeons approached decisions in ways at odds with their preferences. Most of those desired more patient involvement than occurred. Of course, some surgeons might have endorsed shared decision-making not because they prefer it, but because it seems more socially acceptable than Doctor Knows Best.
Who wants what
Four characteristics predicted whether surgeons worked with patients when making treatment choices:
- Numeracy: Surgeons with the worst number skills were likelier than the rest to decide alone. Such doctors may feel uneasy discussing the likelihood of treatment benefits and risks with patients. They may find it easier to just tell patients what to do.
- Experience: The more experience surgeons had, the more likely they were to share decision-making. This suggests that collaborating with patients requires skills that grow with practice.
- Gender: Female surgeons were likelier than males to want shared decision-making. Unlike most of their male colleagues, female surgeons typically made decisions alone, against their own wishes.
- Culture: Individualistic countries, such as the U.S. and the UK, value individualism and self-reliance. Collectivistic nations like Japan put cooperation and the greater good first. In tune with their culture, surgeons from individualistic countries were more apt to go it alone than those from collectivistic nations.
This study adds to research showing that few doctors involve patients in decisions. The same seems to hold for surgeons. Of course, it takes two to share, but the study gathered no data on patients’ desire or ability to make treatment choices. Yet, such factors could and should influence who decides.
The study could not unyoke cause from effect, but it hints that mastering shared decision-making requires practice and a good working grasp of statistical risk information. Medical educators, take note.
These findings offer hope for patients who feel shut out of decisions about their care. If most surgeons truly do want shared decision-making, they want the same approach as many patients do. Knowing that surgeons and patients share this common ground might just help them find more.
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