{"id":7367,"date":"2025-08-05T06:30:00","date_gmt":"2025-08-05T06:30:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=7367"},"modified":"2025-08-05T06:30:00","modified_gmt":"2025-08-05T06:30:00","slug":"as-shared-decision-making-ails-ai-may-save-this-human-interaction","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=7367","title":{"rendered":"As Shared Decision-Making Ails, AI May Save This Human Interaction"},"content":{"rendered":"
\n<\/div>\n

By MICHAEL MILLENSON<\/p>\n

Shared decision-making between doctors and patients may be \u201cthe pinnacle of patient-centered care<\/a>,\u201d but three new medical journal articles suggest it\u2019s encountering more problems than peaks. Yet counterintuitively, it may be artificial intelligence that rescues this intimately human interaction.<\/p>\n

\u201cShared decision-making is at a crossroads,\u201d declares a Perspective in the\u00a0Journal of General Internal Medicine, \u201cSaving Shared Decision-Making<\/a>.\u201d Unfortunately, its more-research-and-education recommendations for \u201cadvancing the science of SDM implementation,\u201d seem more crossing guard than crisis management.<\/p>\n

Even a cursory historical perspective shows that SDM is suffering from a failure to flourish. Back in 1982,\u00a0a report by a presidential commission on ethics in medicine<\/a>\u00a0declared SDM \u201cthe appropriate ideal for patient-professional relationships\u201d and called on doctors \u201cto respect and enhance their patients\u2019 capacities for wise exercise of their autonomy.\u201d<\/p>\n

Yet 43 years later, the Perspective authors \u2013 18 members of the Agency for Healthcare Research and Quality Shared Decision-Making Learning Community \u2013 acknowledged that while some doctors respectfully ask patients, \u201cWhat do you think you would like to do, given these options?\u201d many others still believe that, \u201cLet\u2019s do this option, sound OK?\u201d is a shared decision process.<\/p>\n

That attitude reminded me of a tongue-in-cheek comment by comedian Stephen Colbert. \u201cSee what we can accomplish when we work together by you doing what I say?\u201d he told a 2015 Colbert Nation audience. \u201cIt\u2019s called a partnership.\u201d<\/p>\n

Cancer Communication Curtailed<\/h2>\n

In cancer, where patient-doctor interactions have the highest stakes, shared decision-making was named one of the central components of quality care in a 1999 report,\u00a0Ensuring Quality Cancer Care<\/em><\/a>, by the Institute of Medicine (now the National Academy of Medicine). Nonetheless,\u00a0a review of SDM among cancer patients<\/a>\u00a0in the journal\u00a0Psycho-Oncology<\/em>\u00a0found that for physicians, \u201cmaking decisions and taking responsibility for the decisions remain an important part of the physicians\u2019 professional identity.\u201d The fear of losing this identity, the authors wrote, \u201ctends to hinder the patient involvement and implementation of SDM.\u201d<\/p>\n

Not surprisingly, cancer patients who want to speak up feel as if they won\u2019t be listened to or can\u2019t really refuse whatever their oncologist considers clinically \u201coptimal.\u201d And, it turns out, oncologists are actually less open to SDM if a patient does speak up and resists the recommendations they feel are in the patient\u2019s best interest.<\/p>\n

<\/span><\/p>\n

Meanwhile, for those hoping Gen Z doctors will naturally be more sensitive, a\u00a0JAMA<\/em>\u00a0Perspective, \u201cWhen Patients Arrive With Answers<\/a>, brought discouraging news. When the topic of patients bringing in a treatment recommendation from ChatGPT came up among a group of medical students in the Seattle area, these Internet-native physicians of tomorrow bristled with an old-fashioned dismissiveness of the patient who\u2019s \u201cgoing to tell us what to order.\u201d<\/p>\n

There\u2019s an implicit message that \u201cwe still know best,\u201d lamented Dr. Kumara Raja Sundar.<\/p>\n

AI Addresses Chronic Problem<\/h2>\n

When you take a hard look at SDM use, misuse and non-use, it\u2019s clear this is a chronic problem, not an acute one. Good intentions collide with cultural norms going back to Hippocrates. The idea of patient self-determination, writes medical ethicist Dr. Jay Katz in\u00a0The Silent World of Doctor and Patient<\/em>, represents \u201ca radical break with medical practices, as transmitted from teacher to student during more than two thousand years of recorded medical history.\u201d<\/p>\n

Perhaps equally important individual physicians are increasingly less likely to control their own time. In the 1980s, 80% of physicians worked in practices of ten or fewer doctors, according to the American Medical Association, and the overwhelming percentage of those were in private practice.\u00a0In 2024, for the first time, private practice doctors were a minority<\/a>, at just 42%, and about one in five doctors worked in practices of 50 or more.<\/p>\n

Paradoxically, AI may push shared decision-making onto what is now often an extremely time-pressured agenda precisely because the detailed, personalized level of information that it\u2019s able to force a reassessment of physician professional identity. Similarly, the scale, scope and depth of the AI revolution will also compel the group practice leaders, health system executives, private equity satraps and all others who now pull the strings on so many physicians to adapt to the democratization of medical knowledge.<\/p>\n

There may be no other choice. Already, individuals with breast, lung or prostate cancer can go to\u00a0a well-funded start-up<\/a>\u00a0that will help them transfer their medical record into a platform that compares their treatment plan to the clinical practice guidelines of the National Comprehensive Cancer Network. Separately, a cancer survivor and entrepreneur\u00a0has launched an online platform<\/a>\u00a0to make personalized agentic AI, a sophisticated search of the medical literature, available to every cancer patient. And real-world evidence in cancer care,\u00a0now being marketed to clinicians and researchers<\/a>, will inevitably be available directly to patients. Meanwhile, online venues like the PatientsUseAI Substack help guide those who wish to be full partners in their care how to use the new tools.<\/p>\n

The question no longer will be whether there is shared decision-making, but how it takes place. Sundar, a family physician, suggests \u201crelational humility,\u201d with doctors \u201cseeing AI-informed visits as opportunities for deeper dialogue rather than threats to clinical authority.\u201d<\/p>\n

He adds, \u201cIf patients are arming themselves with information to be heard, our task as clinicians is to meet them with recognition, not resistance.\u201d<\/p>\n

Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor. This first appeared in his column at\u00a0<\/em>Forbes<\/em><\/a><\/p>","protected":false},"excerpt":{"rendered":"

By MICHAEL MILLENSON Shared decision-making between doctors and patients may be \u201cthe pinnacle of patient-centered care,\u201d but three new medical journal articles suggest it\u2019s encountering more problems than peaks. Yet counterintuitively, it may be artificial intelligence that rescues this intimately human interaction. \u201cShared decision-making is at a crossroads,\u201d declares a Perspective in the\u00a0Journal of General…<\/p>\n","protected":false},"author":0,"featured_media":7322,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-7367","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/7367"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7367"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/7367\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/7322"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7367"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7367"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7367"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}