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Sommer I, Assa S, Bachmann C, Chen 陈未 W, Elcin M, Funk E, Kamisli C, Liu 刘涛 T, Maass AH, Merse S, Morbach C, Neumann A, Neumann T, Quasinowski B, Störk S, Weingartz S, Wietasch G, Weiss Weiß A. Medical Care as Flea Market Bargaining? An International Interdisciplinary Study of Varieties of Shared Decision Making in Physician-Patient Interactions. Teach Learn Med 2024:1-13. [PMID: 38577850 DOI: 10.1080/10401334.2024.2322456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024]
Abstract
Phenomenon: Shared decision making (SDM) is a core ideal in the interaction between healthcare providers and patients, but the implementation of the SDM ideal in clinical routines has been a relatively slow process. Approach: In a sociological study, 71 interactions between physicians and simulated patients enacting chronic heart failure were video-recorded in China, Germany, the Netherlands, and Turkey as part of a quasi-experimental research design. Participating physicians varied in specialty and level of experience. The secondary analysis presented in this article used content analysis to study core components of SDM in all of the 71 interactions and a grounded theory approach to observe how physicians responded actively to patients even though they did not actively employ the SDM ideal. Findings: Full realization of the SDM ideal remains an exception, but various aspects of SDM in physician-patient interaction were observed in all four locations. Analyses of longer interactions show dynamic processes of interaction that sometimes surprised both patient and physician. We observed varieties of SDM that differ from the SDM ideal but arguably achieve what the SDM ideal is intended to achieve. Our analysis suggests a need to revisit the SDM ideal-to consider whether varieties of SDM may be acceptable, even valuable, in their own right. Insights: The gap between the SDM ideal and SDM as implemented in clinical practice may in part be explained by the tendency of medicine to define and teach SDM through a narrow lens of checklist evaluations. The authors support the argument that SDM defies a checklist approach. SDM is not uniform, but nuanced, dependent on circumstances and setting. As SDM is co-produced by patients and physicians in a dynamic process of interaction, medical researchers should consider and medical learners should be exposed to varieties of SDM-related practice rather than a single idealized model. Observing and discussing worked examples contributes to the physician's development of realistic expectations and personal professional growth.
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Affiliation(s)
- Ilka Sommer
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Solmaz Assa
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cadja Bachmann
- Office of the Dean of Educational Affairs, Rostock University Medical Center, Rostock, Germany
| | - Wei Chen 陈未
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, PR China
| | - Melih Elcin
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elisabeth Funk
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Caner Kamisli
- Institute of German Studies, University of Hamburg, Hamburg, Germany
| | - Tao Liu 刘涛
- School of Public Affairs, Zhejiang University, Hangzhou, PR China
| | - Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Stefanie Merse
- Empathische Interkulturelle Medizinische Kommunikation, University of Duisburg-Essen, Duisburg, Germany
| | - Caroline Morbach
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Anja Neumann
- Institute of Healthcare Management and Research, University of Duisburg-Essen, Duisburg, Germany
| | - Till Neumann
- Outpatient Department of Cardiology Cardio-Praxis, Bochum, Germany
| | | | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Sarah Weingartz
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Götz Wietasch
- Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands
| | - Anja Weiss Weiß
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
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