How Should Physicians Involve Patients in Medical Decisions?

To the Editor: The article by Dr Braddock and colleagues¹ has been useful in our new course on health communication, especially the table listing the 7 elements of informed decision making. From a statistical standpoint, however, we are concerned that the unit of analysis was the individual clinical decision. The analysis used t tests, χ² tests, and Fisher exact tests, all of which require independent observations. Individual physicians and patients all have past experiences, personalities, and dispositions that result in preferences for certain styles of communication. For example, a physician who has developed a heightened awareness of the importance of good communication may practice more complete, informed decision making with all patients. The physician may therefore be a more appropriate unit of analysis than the individual clinical decision.² On the other hand, patients who take a more active role in the encounter probably elicit more complete information from the physician. When studying the complex process of communication³ within this type of sample, it is important to control for the individual patient and physician when testing for differences in various communication elements in the clinical visit.