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Comment & Response |

Patient-Centered Decisions in Primary Care From Necessity To Realism

Emmanouil K. Symvoulakis, MD, PhD1; Dimitrios Anyfantakis, MD, MSc2; Adelais Markaki, APRN-BC, PhD3
[+] Author Affiliations
1Private Family Practice Unit in Heraklion, Heraklion, Crete, Greece
2Primary Health Care Centre of Kissamos, Chania, Crete, Greece
3Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
JAMA Intern Med. 2014;174(3):474. doi:10.1001/jamainternmed.2013.12878.
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To the Editor We read with interest the study carried out by Fowler and colleagues,1 describing patients’ involvement in the decision-making process for common medical conditions encountered in primary care. Remarkably, decisions about prescribing medication to lower cardiovascular risk (for hypertension and lipid control) were reported to be mostly physician driven, with discussions being oriented toward the pros of medication. In regard to decisions about prostate and breast cancer screening tests, there was very little discussion about harms vs benefits of routine prostate-specific antigen screening and mammography, while patients’ age was not taken into consideration. Another unexpected finding was that decisions made in primary care settings appeared to be more paternalistic compared with those in surgical settings.


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March 1, 2014
Floyd J. Fowler Jr, PhD; Bethany S. Gerstein, BA; Michael J. Barry, MD
1Informed Medical Decisions Foundation, Boston, Massachusetts2Center for Survey Research, University of Massachusetts, Boston
1Informed Medical Decisions Foundation, Boston, Massachusetts
JAMA Intern Med. 2014;174(3):475. doi:10.1001/jamainternmed.2013.12843.
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