Making Decisions Together: Bringing Patients Into the Conversation

It is much more important to know what sort of a patient has a disease than what sort of a disease the patient has.

— William Osler, M.D., 1913

Understanding the patient being treating can sometimes make more difference to treatment outcomes than knowing which disease is being treated. This nugget of wisdom, noted above by William Osler, M.D., the “Father of Modern Medicine,” is just as true now, as when he first said it a century ago. Today, Dr. Osler’s idea is mirrored in the theory of “shared decision making,” a collaborative process in which health care providers involve the patient in the decision process.

A recent editorial in the British Journal of Dermatology by Alex Anstey, M.D. explored this issue of shared decision making. In it, Dr. Anstey conveyed his experience treating a patient with psoriatic arthritis. At first, Dr. Anstey assumed that the treatment plan was successful since the main joint issues were seemingly under control.

Only after spending time with the patient did Dr. Anstey discover that the patient considered his treatment a failure since the still-present psoriasis on his hands meant he couldn’t work in his chosen profession, as a chef. A new therapeutic plan was enacted and the patient was then able to return to work as a chef.

As Dr. Anstey explains, with shared decision making:

“The goal is to identify the most appropriate treatment for the individual patient in their circumstances and with their opinions, values, beliefs, preferences, and goals. In short, this depends on understanding what is most important to the individual patient through the process of shared decision making.”

Shared decision making becomes even more important when treatments come with adverse side effects or adherence challenges. Fully informed and engaged patients are better equipped to weather the difficulties of a given treatment. Specialty pharmacies work with patients facing complex diseases; which means that side effect management is often part of the process. The more a patient is informed and given tools to help manage these side effects, the more likely it is for the patient to stay compliant (even in the face of challenges) and achieve the best outcome.

In our practice at BioPlus, every patient has access to a patient care coordinator and clinical pharmacist. The patient works with this team to create realistic goals of pharmaceutical care. The care plan’s progress is communicated to the prescriber so this valuable information can be used in monitoring, assessing, and making necessary changes in the therapeutic care plan. Thus every patient is treated person-to-person and not as simply a disease or patient on a medication therapy.

It’s a shared decision.

Stephen C. Vogt, Pharm.D.
President and CEO
BioPlus Specialty Pharmacy


What do you think?

I’d love to hear your opinion in the comments section below.



Anstey A, Edwards, A. Shared decision making in dermatology: asking patients, ‘What is important to you?’ Br J Derm 2014;170(4):759-60.

One Comment Add yours

  1. indyhotspur says:

    This was thought-provoking and useful. In 2014, we have many fewer private physician practices and many more cases where the physician is an employee. For better or worse, time spent by the physician with his/her patient has become a business metric. Yet, as you point out in your example with the psoriatic chef, it is vital for the physician to get to know the patient well enough to understand his/her own personal goals for treatment Treatment is not a success until/unless the patient’s goals are met.

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