Below is an excerpt from a full, free editorial, which is the way the New England Journal of Medicine editors skillfully focus attention on a topic editors deem important.

In this commentary, the authors have written about the importance of hard-won gains in patient-physician shared decision-making.

It is a short piece—-worth reading—-which explains clearly how various forces at work need not collide as part of health care reform.

Shared decision-making—-again, between patient and doctor—-is one of the most important developments in contemporary medicine. This is nothing less than the way things should always have been. They most definitely were not as recently as the 1970s.

It is the doctor’s role to provide information, judgment and guidance. It is the patient’s role to weigh that information and then choose what the patient feels is right at the time.

It sounds so simple. It is anything but.

New England Journal of Medicine

…”In the debate over health care reform, much has been made of the WHO’s ranking of the United States as 37th in health care overall.¹ What is not emphasized is that we are rated first in responsiveness — that is, in providing patients with choices that are meaningful to them. We scored poorly on the variables related to economics and fairness in distribution of services, and these factors will be addressed through the reform measures that are now in the works. Retaining our hard-won advances in shared decision making will allow us to ethically combine the contributions of medical humanism and evidence-based guidelines while addressing the imperatives of cost containment and universal coverage.”

(The authors are physicians. Pamela Hartzband is from Beth Israel Deaconess Medical Center and Jerome Groopman is from  Harvard Medical School, which are both in Boston.)

Source: New England Journal of Medicine, Online post, August 5, 2009