Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here’s what it’s about:
Anyone who has ever received a frightening diagnosis knows that what the doctor says next may not make much sense. Just hearing that your condition is serious can send your brain hurtling through space so that you have difficulty hearing and processing the description of next steps. Yet treatment often goes better when patients participate in the decision about what to do.
How can doctors and patients overcome the barriers that keep them from clear communication? What is the best way to approach shared decision making? Dr. Peter Ubel has looked at these thorny questions from both sides of the stethoscope. He shares his thoughts.
Guest: Peter Ubel, MD, is a physician and behavioral scientist at Duke University. He is the author of several books, including You’re Stronger Than You Think: Tapping Into the Secrets of Emotionally Resilient People, and Free Market Madness: Why Human Nature is at Odds With Economics–and Why it Matters. His new book is Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. His website is www.peterubel.com
The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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  1. Adam T.
    Reply

    I found the discussion to be very interesting. I am a person living with a chronic disease and I also work in clinical quality management helping build patient involvement programs to support partnerships in quality improvement. His framework and in particular the values-based decision-making was spot on.
    The analogy of what are you watching on TV was also quite interesting.
    Great show.

  2. DHA
    Reply

    In general, I found the talk with Peter Ubel interesting and pertinent. However, as I reheard some of it on Sunday, I found myself getting quite irritated with what seemed to me like the servile tone Joe was taking with Peter.
    Hey, we are paying for the service of the physician, and paying very dearly and there are many to take the place of the one we are seeing. Why shouldn’t we expect to be treated like a valued customer? We obviously have some dysfunctional attitudes and habits about medical practice in the USA and that is part of the reason we pay 50% more for our health care than any other nation in the world.
    If I were professional practicing in a sector of the economy that was year after year milking the nation for an excess 6% of GDP I don’t think I would expect my customers to be servile and in awe of me; I’d expect them to come in with questions and concerns about how well they were going to be treated and it would be my job to establish my appreciation of their business and the value of what I do and the fairness of the fees I charge.

  3. East-Slope Clarlie
    Reply

    As someone who’s come through Laryngeal Cancer with a Total Larynjectomy and still taught college for YEARS and helped form clubs and support groups – the BEST two things anyone can do when facing a ‘scary’ diagnosis (and ‘scary’ is to YOU, NOT ANY ONE ELSE!) is 1) bring in a tape recorder and ASK PERMISSION to use it – so you remember if you’ve heard things right when you need to know what the doctor really said, AND
    2) bring in a TRUSTED friend, who has a list of questions you have made from your Web-Searches – and makes sure that ALL of them are answered. Doc’s don’t know your level of biological/medical understandings, so they often try to keep things either over-simplistic, or use words you don’t understand (and don’t be afraid to say you don’t understand the word – and here’s where a friend helps too — they can say it for you. A hint is even if you think you know some biology reasonably well (I have two MS’s in Bio Sciences and don’t have a clue what’s happening in the real world they were from soooooooo long ago).
    And having taught college (and K-12) for SO many years, I can say that THERE ARE NO ‘IGNORANT QUESTIONS’ – or ‘STUPID IDEAS’. And By ‘Ignorant’ I mean not knowing. “Stupid” is knowing you don’t know and don’t want to find out. Stupid people seldom succeed, but you sure see a lot of ignorant people (and I’m one in MANY subjects) do VERY well on a job site. It’s because they ask questions about what they don’t know or misunderstand.
    That is what your friend is for – you two can walk through it together, write out the questions that need to be asked, and then THEY make sure that the answers are given –
    If it’s VERY serous, NPR has a Science show, RadioLab that has a ‘short’ (about 20 minutes) pod-cast on “The Bitter End” — where they talk to physicians, nurses, and other health care professionals about how they’d want to transverse a serious illness. There is a graph on the pod-cast page — worth looking at. As a former Corpsman and Paramedic I gotta say I agree with most of their decisions (http://tinyurl.com/b82jbh7), or just Google it under RadioLab.
    TAPE RECORDER
    LIST OF QUESTIONS
    A *TRUSTED* FRIEND.
    Then you’ll be on top of things. I know after I heard the word ‘cancer’ (at 38?) I had to call the doc to make a second appointment to hear the rest – and he made it for that evening. And I’d BEEN a corpsman and WAS a paramedic! – but didn’t understand a word. I went into the ubiquitous ‘deafness’ after hearing ‘bad’ news. Turned out to be some of the best news I could have gotten! But didn’t know it at the time! —

  4. James Daniels
    Reply

    A decade ago, the Institute of Medicine called for patient-centered care as one of the 6 key elements of quality health care, which enlists physicians in considering patient preferences, values, and needs when making clinical decisions. Safety experts believe greater patient participation in care and decision making will improve safety.
    I wondered what Dr. Ubel would advocate regarding the role of nurses and how the physician/patient communication might also include the physician/nurse dynamic. Nurses are also integral to the shared decision making process that challenge the patients. I ordered his book because the influence of culture and beliefs also impact the shared decision making event.

  5. J. David Auner
    Reply

    Good discussion. I cringed a little when the topic of prostate cancer came up – not one of medicine’s finest decades or two decades for this disease.
    I had a life changing experience as a lab tech with crossmatched blood ready for a comatose teen who had been stabbed too many times but really the surgeons would have had time to repair her injuries with transfusion support. Out of state parents said not to give her blood for religious reasons and she died.
    Later in practicing medicine I had conversations with similar religious patients who were firm in their beliefs and said to let them go without transfusion if a similar situation arose. I accepted their decision for themselves but let them know that decision could not be accepted for minor children. A court order and necessary treatment were what I thought, and still think, are what is ethical for children. No families left my practice as a result of this discussion.
    Thankfully, in 26 years of practice, the situation did not arise.

  6. Gordon
    Reply

    You have ignored what may help patients make a decision. Use someone else to work with the patient. Using a chaplain, social worker, or councilor to help the patient explore what they want to do. Having someone other than a doctor helps greatly.

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