#SDM – a floor, not a ceiling

I am a patient, caregiver, and nurse – an advocate of shared decision-making (#SDM).  My health team operates in a collaborative process that allows us to make health care decisions together, taking into account the best scientific evidence available, as well as my values and preferences. (See this site for more info.). Click here for my other posts about SDM. Yet SDM sometimes makes me feel agitated and disappointed. SDM is a floor, not a ceiling – necessary but not sufficient. 

What decisions? The SDM social media talks much about how patients and clinicians can more collaboratively decide which medication, treatment, or surgery to use? Yet health is way more than an individual’s medication, treatment, or surgery. It’s feeling safe, having enough to eat, being respected, clean air and water, literacy and learning, getting from one place to another, care of family, companionship and community. Or as the professional community refers to it: social determinants of health and as people refer to it: life.  Then there are the decisions that affect my health upstream – legislatures, insurers, lobbyists, companies making decisions. I suggest that their decisions affect our health too.

Who’s sharing? Again, the focus is on patients and their doctors. But when does the medical team communicate and make decisions with the non-medical health team? Rarely. I make more decisions with my massage therapist, acupuncturist, physical and occupational therapist and chiropractor, than I do with my doctors and nurses. They almost never talk to each other. No time, no space, no chance.

My problem is that I don’t expect patients and clinicians to grapple with all this in their infrequent 5 to 30 minutes together. It’s too much. But if government, employers, and people want to move the dial significantly for better outcomes, more affordable health and healthier neighborhoods the conversation needs to be bigger. I have ideal SDM in my team but it’s not sufficient. I don’t know where to go with this rant. We – epatients, caregivers, and professionals – need to expand our view and our scope while we’re not mired in needing to make those choices about our medical care.

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