As a fellow researcher in the psychology of medical decision making, I've had the pleasure of following Dr. Ubel's innovative work for years. In Critical Decisions, he applies his notable skills as a physician, a bioethicist, and a behavior scientist to explain how patients and physicians can find themselves stymied by the need to work together to make medical decisions and how patients, in particular, can make better decisions.
The book begins with a historical account of the emergence of "patient autonomy" in medical decision making as a moral and legal paradigm, and shows why putting medical decisions solely on the patient, although perhaps a necessary counterweight to centuries of physician paternalism, is also highly problematic, particularly in light of the psychology of decision making which challenges the assumption that simply informing patients is sufficient to enable them to make better decisions. Ubel traces the much more recent ascent of "shared decision making", including the development of patient decision aids, and points out the need for improvements in both patient and physician communication. As patients being more active, he points out, physicians need to be better prepared for active patients. He concludes with eight tips for patients to better partner with their doctors.
Ubel has a real flair for explain complex ideas - medical, legal, economic, or psychological - in straightforward and readable language. He makes effective use of his own experiences with patients (and as a patient) to showcase the kinds of issues that arise in shared decision making and point a way forward.
Because I know Ubel's work well, I know there are fascinating and important studies that didn't make it into this book. For example, he points out that people without a colostomy assume that living with a colostomy will be worse than it is (according to people who have a colostomy), but he doesn't cover his later study that shows that even people who have formerly had a colostomy (since reversed) also misremember what it was like and return to assuming that a new colostomy would be worse than their past experience would suggest. Of course, collecting all of Ubel's findings would take several additional volumes, so it's not much of a fault. Hopefully, this will lead readers to explore Ubel's (and other) further work beyond the book.
In summary, this is an excellent and engaging book for people interested in more meaningful partnerships with their physicians (as well as for physicians trying to understand how to partner with their patients). It's going on my Amazon list of great books on medical decision making.
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Top reviews from other countries
- MeghaReviewed in India on June 30, 2018
Great read to understand the patient choice revolution
