Missed expectations? Physicians' views of patients' participation in medical decision-making

Med Care. 2005 May;43(5):466-70. doi: 10.1097/01.mlr.0000160415.08497.11.


Objective: Physicians are encouraged to actively involve patients in clinical decision-making, but this expectation has not been adequately examined from the physicians' perspective. Our objective was to identify and characterize physicians' attitudes toward patient participation in decision-making and to gain insight into how they consequently think about and structure the decision-making process.

Design: This was a qualitative cross-sectional study of physicians' reported attitudes and practices.

Setting: The study took place in private practice and academic physicians' practices.

Participants: A total of 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired, participated in the study.

Measurements: We performed a qualitative analysis of semistructured individual interviews.

Results: The physicians in this study expressed consistently positive attitudes toward patient participation in medical decision-making. They identified patient autonomy as an essential justification for patient participation but often went beyond an autonomy-based rationale. Several were motivated by the fundamental principle of beneficence as well as their own self-interest in avoiding legal liability. Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process; others took a more collaborative approach, encouraging patients to assume decisional priority. The decision-making process often was modified by patient, physician, and environmental factors.

Conclusions: The physicians in this study demonstrated a positive, flexible approach toward including patients in decision-making. A one-dimensional model of shared decision-making based solely on the principle of autonomy fails to account for variability in how physicians allocate decisional priority and is therefore ethically inadequate.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Academic Medical Centers
  • Attitude of Health Personnel*
  • Beneficence
  • Cooperative Behavior
  • Cross-Sectional Studies
  • Decision Making* / ethics
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Patient Participation*
  • Personal Autonomy
  • Physician's Role
  • Physician-Patient Relations* / ethics
  • Physicians / psychology*
  • Private Practice
  • Professional Autonomy
  • United States