To the Editor: Dr Braddock and colleagues1 found that 91% of patient-physician interactions
failed to meet their definition of informed decision making. However, this
snapshot approach ignores the context of the patient-physician relationship.
Every intervention is negotiated with each patient, and both sides have expectations
based on prior interactions, which lay the groundwork for a productive relationship.
Each interaction, however, must stand on its own merits. If we fail the patient's
expectations this time, next time we have to rebuild or the patient will need
to start over somewhere else. Patients become comfortable with a relationship,
which varies in its paternalism or autonomy depending on the decision at hand.
Trust, therefore, is earned. Without it we have to go through a cumbersome
decision framework bit by bit, warily sparring back and forth until there
is a comfort level of trust.
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