M.D.s fail to involve patients in decision-making process.

Surgeons and primary care physicians seldom provide patients with the information they need to make an informed decision on their health care. That was the conclusion reached by a report in the December 22/29, 1999 issue of the Journal of the American Medical Association (JAMA).

Researchers made audiotapes of 1,057 physician visits and counted a total of 3,552 clinical decisions during those visits. Yet, just nine percent met the researchers' criteria for completeness for informed consent. The situation was worse when it involved a complex decision. Then, only one-half of one percent of the patients were given complete information.

The study consisted of 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons.

The criteria for informed decision making used in this study include discussion of: 1) the patient's role in decision making; 2) the nature of the decision; 3) alternatives; 4) pros (benefits) and cons (risks) of the alternatives; 5) uncertainties associated with the decision; 6) the patient's understanding of the decision; and 7) the patient's preferences.

The researchers found that in general, surgeons had more completeness of informed decision making than primary care physicians, possibly because surgeons are experienced in obtaining written consent for surgery, which may carry over into being more accustomed to discussing other decisions with patients.

Many health care advocates have demanded that patients be given full information about every treatment of procedure, and play an active role in the decision-making process. As it stands today, most are given only a biased description of the treatment and no details on risks or alternatives.

The researchers wrote that "this low level of informed decision making suggests that physicians' typical practice is out of step with ethical ideals. There are practical implications of this missing practice."