I hate shared decision making

[u/RawrLikeAPterodactyl]

I really try not to tell docs I’m a resident bc I don’t want them coming in with assumptions. That being said I’m pretty sure it’s on my chart because they all know. Anywho PLEASE FOR THE LOVE OF GOD STOP ASKING ME WHAT I WANT TO DO JUST TELL ME. I am at your office because I DONT KNOWWWWWW. Literally hate when they’re like well what do you think. Girl I don’t wanna think right now. If I had an opinion I would bring it up. Let me be a patienttttt.

[u/WhereAreMyDetonators]

Well, it’s like this because society decided that getting instructions from your doctor on how to treat your condition was too paternalistic, so now you have to come up with a treatment plan and psyop the patient into thinking it was their brilliant idea.

As a patient I hate it and I always tell the doctor I’m seeing that it’s their expertise I’m here for. I wouldn’t tell a plumber how to do their job either, that’s why I called one.

[u/WhattheDocOrdered → u/WhereAreMyDetonators]

You nailed it with this. I like to fully assume the patient role when I’m seeing a doc outside my specialty. I disclose that I’m a physician to hopefully ease some of the burden on them to break absolutely everything down to layperson understanding. I’m also exhausted from doing the equivalent of whispering my plan to my own patients because god forbid you give a firm opinion to someone who allegedly came in seeking your opinion lest you come on too strong and upset them.

So I gave up and decided to be blunt and man has it been refreshing. I hope my own doctors will return the favor because I value their expertise.

[u/DevilsMasseuse → u/WhattheDocOrdered]

Yeah there’s a surprising lack of candor in medicine now. People want experts to not hedge and give their opinion on the best course of action. You can add in as much nuance as you want but people eventually want you to get to the point and come up with a plan.

As soon as I stopped hedging and just started telling people what I thought they should do, they started trusting my judgement better. If you hedge too much, they think you don’t know what you’re doing.

[u/katyvo → u/WhattheDocOrdered]

I tell docs (including my cats' vet) that I'm a doc not for special treatment but so they don't feel the need to launch into the "an antibiotic is a special class of medications meant to fight bacteria. we have bacteria all throughout our body, but sometimes we get them where we don't want them. it's very important to finish all of this antibiotic..." spiel or equivalent

[u/Comprehensive_Wash71 → u/katyvo]

The surgeon who admitted me for cholecystitis and a common duct stone was very relieved that he didn’t have to draw me a diagram to explain my MRCP results, or how EGD and stone removal works, or how a lap chole might conceivably have to be converted to an open procedure.

[u/InsertWhittyPhrase → u/WhereAreMyDetonators]

I'm an attending now, but as a resident, we had an obstinate attending who loved disagreeing with your plan, so you had do use the same psychologic strategy on them. As a senior, I would tell my juniors: "You have to lead the horse to water, and then make him think it was his idea to drink."

[u/WhereAreMyDetonators → u/InsertWhittyPhrase]

I liken it to the movie My Big Fat Greek Wedding with the women talking about how they get the patriarch of the family to do things. Make him think it’s his idea.

[u/PossibilityAgile2956 → u/WhereAreMyDetonators]

As a relative of several electricians I believe yes people absolutely will tell their plumbers how to do their job.

[u/WhereAreMyDetonators → u/PossibilityAgile2956]

I don’t doubt they will; but they probably shouldn’t

[u/IllRainllI → u/WhereAreMyDetonators]

A perk of being a rheumatologist is this is not a very big issue for us. Patients usually trust our plan bc their diseases are too complex. A patient literally said to me once "i don't care if my chances of getting cancer are high i wont stop the medication that healed my pain"

[u/Comprehensive_Wash71 → u/WhereAreMyDetonators]

I mean, I had 2 years of general/trauma surgery followed by a year staffing a tiny rural ER, followed by radiology residency and IR fellowship. If I’m talking to my surgeon because I have a dying gallbladder and a common duct stone, you bet I’m telling him that he can talk to me peer-to-peer. (Real story from 2019 and I’d been retired for a while and never practiced in the state where I currently live.)

OTOH if I get an ophthalmologic problem, or autoimmune disease, or cancer, or a derm problem, I know NOTHING and I want my specialist to tell me what to do!

[u/WhereAreMyDetonators → u/Comprehensive_Wash71]

True but as an anesthesiologist I rarely need to be intubated

[u/adoradear → u/Comprehensive_Wash71]

I’m emerg. I tell my doctors I know a little bit about a lot of things, but since everything I know is the emergency part, I’m not the expert in this part, so please give me your expertise and I will trust it (and will ask questions if I’m unsure).

[u/ThotacodorsalNerve]

Mine have mostly been OBGYN appts recently cause I’m currently gravid and I just start off by telling them that OBGYN was my worst subject in med school and just to tell me what to do.

[u/vogueflo → u/ThotacodorsalNerve]

1) I love your username (I may have even commented this to you before now that I think about it)

2) I love that you call yourself gravid it makes me giggle

[u/Ryantruffled → u/ThotacodorsalNerve]

Lol that’s smart. Saying it upfront basically lets them take the wheel. Once they know you’re not trying to weigh in, they usually skip the whole “so what are you thinking” part.

[u/Jquemini]

Just say, “what would you do if you were in my shoes?” Easy peasy.

[u/DAggerYNWA → u/Jquemini]

“That’s funny you ask me, I was just about to ask what you would do in my shoes!”

[u/Jquemini → u/DAggerYNWA]

If they say that, fire them

[u/Ananvil → u/DAggerYNWA]

Demand their shoes.

Leave.

[u/Somali_Pir8]

Dude, I love shared decision making. Patient doesn't want inpatient workup. Boom, Discharge. And if they say something idiotic, just get them to explain themselves. Like once, they wanted me to transfer to another hospital. Cause they were weak (hospitalized for a week, didn't want to work with PT). I told them what should I tell the other doctor? They couldn't come up with anything, so they stayed.

[u/DocBigBrozer]

I get it, and if you insist, I'll make that decision for you. But I also wanna hear your preference given our options. Share decisions are a good thing when done properly

[u/bearpics16]

I never understood this. I provide a few options and then give my opinion on what I believe to be the best and why each other option may not be the best. Patients often don’t understand the ramifications of the alternatives. I’ve never had a patient complain, and I feel like I have a very for relationship with them.

[u/meddwannabe]

Agree but also I have noticed that the care I get is much better when my doctors know that I’m a resident :(

[u/anhydrous_echinoderm]

Bro

Docs do what other docs wanna do.

[u/sonatainthekeyoflife]

I hate it when docs don’t tell me they’re docs when I see them in clinic. So, so much.

[u/Historical-Flamingo6]

It's in my chart that I'm Physician and I have to tell anyone who brings that up "please treat me like everyone else and assume I know nothing about medicine" I also have to tell them I have white coat syndrome and I get anxiety as a patient.

[u/HolyMuffins]

I hear you. That sucks. I'll complain more below.

"Shared decision making" as often performed is a bad model.  Explore the patient's perspectives. Tell them the worst case scenario, best case scenario, and most common scenarios with the different treatment options. Tell them reasons why someone may choose one vs the other. And then say, hey you sounds like someone who values X and wouldn't want Y to happen, so I recommend we do A because it gives us the best pathway to having B. Actually recommend what you think is the best thing for them and tell them why. If they don't agree with your logic, they'll tell you and you can share the decision making then. 

Your particular issue is probably also them just wanting to be polite. Because the conversations where you've got a physician patient looking for something in particular and you are less convinced on the need for testing, etc. can be a bit awkward.

[u/dracrevan]

Then tell your doc that. I have plenty who respectfully and nicely say: “you’re the specialist, I trust you, please tell me what to do” and then I proceed as such. Now if ur doc continues to play that middle ground, be a bit firmer.

Shared decision making has helped me win over innumerable difficult or on the fence patients

[u/futuredoc70]

Imagine how the patients feel who have no medical background. We’ve gone too far

[u/whatareyouguysupto]

I'm a huge fan of shared decision making as a doctor and believe it benefits a lot of patients (and helps to reduce my liability). As a patient, I personally don't care for it. Hell I see an NP and it's like if I had an opinion I'd be tell you it up front, what is this bump om my leg Nicole, I have other shit to think about. I just tell her to tell me.

Just tell them you want them to take the wheel.

[u/gir1withknives → u/whatareyouguysupto]

I endorse shared decision making as a doc. Unless there’s only one reasonable option, I offer options (surgery vs observe, have surgery now vs later etc). I explain what are reasonable expectations.

It helps pts feel less out of control.
It helps them OWN the decision. Bc this is their body dammit.
It builds a relationship with the pt and makes me more likeable. Ppl don’t sue ppl they like.

Having said that I ALWAYS want to be treated like a pt when I’m a pt. Bc the doc works off a routine and I NEVER want to disrupt the routine by being extra. I went to discuss MHT w my pcp and she was like ok here 🤦🏻‍♀️

[u/I_only_eat_protein]

You go in because you’re tired of deciding and they hand it right back to you. Try asking “what would you do if it was your mom?” Usually gets a real answer out of them.

[u/xumoli]

I needed a PCP appointment quick and saw a NP and she found out i'm a resident and now she asks what I** want and i'm like noooooo this is not what i came here forrrr

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[u/InquisitiveCrane]

I mean, I’d rather them do that with me. I hate unnecessary work ups when people play CYA medicine.

[u/Ok-Internal3027]

I have some really rare conditions that I am dealing with right now, which I have poured countless hours researching. I am way more familiar with these things than any other doctor I see, save the specialist. I do think I'm going to voice my opinion when all that my PCP has to go by is a quick 15-minute conversation versus my hundreds of hours of Deep dives into literature.

[u/zeratmd]

Sometimes more than 1 choice is reasonable, but someone with a different value set might prefer to do one or the other depending on the pros and cons. So I do include them in the decision in that case. I often do just straight up ask what they want to do after explaining everything. If one option is the best I just say it’s the best.

[u/Caramelbrownie_MD]

Lol this pissed me off too when I was having surgery and they wanted to include me in the plan. I was already in the ward overstimulated hearing the rounds go on around me. Like, I am mortified just being here and I'm in pain just do whatever you want bro honestly.

[u/Mostlyquiett_]

There’s a difference between explaining my options and making me choose the treatment plan myself. I want the first one.

[u/Medidance]

even worse when the patient was a nurse or retired doc