Improving Medical Decisions

Abstract

In this chapter we conceptualize medical decisions in three steps: diagnosis, option assessment and shared decision making, with specific attention to how these steps apply to decisions in neuropalliative care. Diagnosis is a step that involves gathering information surrounding the problem. A physician must diagnose the medical problem, the problem from the patient’s perspective and the patient’s preferences and values. An assessment of patient capacity and skilled communication are intrinsic to the process. Option assessment is a step where the potential solutions are weighed against each other. This includes assessing benefits and risks of each option including a consideration of costs; understanding and managing uncertainty including the use of time limited trials and default options; and considering the biases associated with option assessment and ways to debias. Finally, shared decision making is a step that involves engaging with patients or surrogates to arrive at a medical decision. This involves incorporating patient values. The objective of a medical decision is to promote patient well-being.