Psychiatry has long been considered the medical specialty most attuned to listening to the patient. With few diagnostic laboratory or imaging tests available or other physical indicators of illness, psychiatrists have been trained to attend carefully to their patients’ histories and subjective reports of symptoms to make a diagnosis and determine the course of treatment. But the nature of the doctor-patient relationship was traditionally one-sided. Patients talked and their physicians listened, and then the doctor prescribed the treatment and the patient followed.
But now psychiatry is changing as the field of medicine adopts patient-centered care. This model of care places greater emphasis on patients’ involvement in determining the goals of treatment that are meaningful to them and the nature of their care. Meaningful goals for patients generally go beyond symptoms to include quality of life, functioning, and a sense of hope and self-efficacy. Patient-centered care isn’t just about putting the patient at the center of the care equation. Rather, it shifts the balance of authority and responsibility of the doctor-patient relationship and incorporates shared decision making (SDM) between the clinician and the patient, particularly when it comes to treatment.
SDM is defined as “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.” Practicing SDM requires that psychiatrists assess the patient’s interest in participating in decisions, providing information on the risks and benefits of specific treatments or approaches in an understandable format, and dialogue with patients about their choices. SDM does not mean that psychiatrists don’t make strong recommendations; rather, it means that those recommendations need to be reconciled with patients’ views and choices.