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Editor's Correspondence |

Physicians Recommend Different Treatment for Patients Than They Would Choose for Themselves

David Alfandre, MD
Arch Intern Med. 2011;171(18):1685. doi:10.1001/archinternmed.2011.457.
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In their article, Ubel et al1 have provided additional data to assist physicians in helping patients make better health care decisions. While their results are unambiguous, the authors' conclusions may benefit from further consideration. Their methodology described physicians providing a recommendation based on a fixed set of circumstances relating to the risks, benefits, and alternatives of a particular intervention. Although the authors mentioned that “the best choice . . . depends on the relative value a given patient places on avoiding these complications vs reducing his or her chance of death,”1(p631) they did not include or account for this critical element of the shared decision-making process, that is, eliciting a patient's values.2,3 Shared decision making is a process of “decisions that are shared by doctor and patient and informed by best evidence, not only about risks and benefits but also about patient-specific characteristics and values.”4(p766) Their methodology leads to a physician recommendation that is made in the abstract rather than one based on a patients relevant values. This article may help to illustrate what is so important about the ideal of shared decision making—that a failure to elicit a patients values results in recommendations that more reflect what a physician would choose for themselves rather than what their patients want.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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