One more thing: shared decision making has been a huge net negative in real life. We did not need this concept as it is inherent in proper doctoring. Always was.

@drjohnm I think you better rephrase your statement as it is not understood.

@drjohnm Interesting

@drjohnm Respectfully disagree--just because ideals of SDM (eliciting preferences, presenting options, discussing risks/benefits, etc...) align with principles of good doctoring doesn't mean they happen in practice. SDM tools have an impt role to play in helping doctors doctor better.

@drjohnm We need good doctors. Sometimes that’s telling people what to do.

@drjohnm Some doctors have a more coercive style. I think it was intended to model balance, where the patient’s values and risk tolerance were part of the decision.

There's no such thing as a shared decision in any given situation with a significant knowledge asymmetry. And it is unfair to the patient to leave technical and complex matters to their own responsibility. I once saw a cardiac surgeon say to a patient that the decision on operating was on him! How come? This is just irresponsible.

@drjohnm A good discussion of this important but complex topic is poorly suited to X, but I can assure you that there was a great need for a new conceptualization "proper doctoring" in the era in which SDM arose. I agree tho that the oft proposed SDM approach is problematic 1/

@drjohnm agree that sdm should be a fundamental part of doctoring, but hugely disagree that it was latent in practice patterns. Ask any trainee - we *still* frequently work w doctors who think paternalism is the right way to practice.

@drjohnm We should try this with air travel next.

@drjohnm Why net negative? I can only imagine you mean when we make it explicit then it gets in the way, but when it was in previously in the background that it functioned as it should

@drjohnm Shared decision-making is the basis for decisions with trade offs. I think respecting patients’ preferences and empowering their voices when choosing between revasc, valve intervention, and initial oHCM treatments is highly important. I think our patients feel similarly…

@drjohnm Surely you don mean to sound quite so arrogant ?

@drjohnm Checks and balances are welcome

@drjohnm What we need is a more authoritarian, no questions asked communication style among doctors. It would be much more efficient. The job would be a lot easier without having to answer pointless questions from possibly stupid patients.

@drjohnm It’s a part of every discussion. Have arthritis? Want an injection? Bracing? Want surgery? “Doc, what would you do if I was your mother?”

@drjohnm More centralized healthcare trying to take credit for what professional medical practice is.... that is... unless it comes to shared decision making on mandates, eh?

@drjohnm That goes for HIPAA too. Confidentiality was always part of medical ethics.

@drjohnm We agree. It’s ridiculous.

@drjohnm How can something be negative if it is inherent in proper doctoring?

@drjohnm Wait, what? It’s inherent in proper doctoring, and also a huge net negative?

@drjohnm Can you give me your def’n of shared decision making or the paper that provides it

@drjohnm Could you expound on the “net” ?

@drjohnm So very right👏

@drjohnm You advise the patient. “Don’t smoke, treat your blood pressure, don’t eat processed foods”. Patient does what they want.

@drjohnm Totally agree, a good doctor will always engage the patient when making a decision and treatment plan

@drjohnm Since it is inherent in proper doctoring, why is explicitly talking about it a net negative? (asked by a healthy minimizer).

@drjohnm is that claim backed by evidence though?

@drjohnm Participating in multidisciplinary discussions, accepting their conclusions, then explaining them to patients and making shared decisions with them—this is one of the most tiring and difficult parts of modern medicine.