Patients at the center: In our practice, and in our use of language

EditorialJanuary 1, 2004Patients at the center: In our practice, and in our use of languageGordon Guyatt, MD, Victor Montori, MD, P. J. Devereaux, MD, Holger Schünemann, MD, Mohit Bhandari, MDGordon Guyatt, MDDepartments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.), Victor Montori, MDDepartments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.), P. J. Devereaux, MDDepartments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.), Holger Schünemann, MDDepartments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.), Mohit Bhandari, MDDepartments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2004-140-1-A11 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail In a formerly widespread approach to medical decision-making, physicians made a diagnosis, considered the management alternatives, and informed patients what would be done to help them. Decision-making rested exclusively in the physicians' domain.This parental model of patient care challenged clinicians to interpret what was best for their patients. How much benefit must a treatment offer before it was worth subjecting a patient to its short-term side effects, long-term risks, inconveniences, and costs? With the clinician at the center of decision-making, the question was whether a treatment effect was "clinically relevant." Even in the discipline of health-related quality-of-life measurement, investigators ...References1 Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Med Care. 2000;38:335-41. [PMID: 10718358] Google Scholar2 Stapf C, Mohr JP. Ischemic stroke therapy. Annu Rev Med. 2002;53:453-75. [PMID: 11818485] Google Scholar3 Inzerillo A, Iqbal J, Troen B, Meier DE. Skeletal fragility in the elderly. In: Cassel CK, ed. Geriatric Medicine: An Evidence-based Approach. 4th ed. New York: Springer-Verlag; 2003. 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[PMID: 7853627] Google Scholar12 Devereaux PJ, Anderson DR, Gardner MJ, et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study. BMJ. 2001;323:1218-22. [PMID: 11719412] Google Scholar13 Whelan T, Sawka C, Levine M, et al. Helping patients make informed choices: a randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer. J Natl Cancer Inst. 2003;95:581-7. [PMID: 12697850] Google Scholar14 Edwards A, Elwyn G. Evidence-based Patient Choice: Inevitable or Impossible? New York: Oxford University Press; 2001. Google Scholar15 Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651-61. [PMID: 10452420] Google Scholar16 Little P, Everitt H, Williamson I, et al. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ. 2001;322:468-72. [PMID: 11222423] Google Scholar17 O'Connor AM, Stacey D, Entwistle V, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2003;(2):CD001431. [PMID: 12804407] Google Scholar18 Berger M, Muhlhauser I. Diabetes care and patient-oriented outcomes. JAMA. 1999;281:1676-8. [PMID: 10328053] Google Scholar19 Sweeney KG, MacAuley D, Gray DP. Personal significance: the third dimension. Lancet. 1998;351:134-6. [PMID: 9439510] Google Scholar20 Early Breast Cancer Trialists' Collaborative Group. Treatment of Early Breast Cancer: Volume 1–Worldwide Evidence 1985-1990. Oxford: Oxford University Press; 1990. Google Scholar Author, Article, and Disclosure InformationAffiliations: Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.)Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.G., V.M., P.J.D., H.S., M.B.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPatients at the center: in our practice, and in our use of language David S. Goldfarb Cited byOpioid Analgesic Use and Risk for Invasive Pneumococcal DiseasesToshihiko Takada, PhD and Yuki Kataoka, MD, MPH January 1, 2004Volume 140, Issue 1Page: A11KeywordsArrhythmiaAtrial fibrillationCardiac outputDrugsEjection fractionEnzyme inhibitorsHeartHeart failureHemorrhageHypertensionLipid profilesMyocardial infarctionPatient advocacyPatientsPrevention, policy, and public healthQuality of lifeStrokeTreatment guidelines ePublished: 9 March 2020 Issue Published: January 1, 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

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