Keywords: Shared decision making, health care decision aids, treatment, patient responsibility, patient empowerment, behavioral economics, bioethics, doctor patient communication, informed consent.
Citation: Balcu I. Book review: Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. J Participat Med. 2012 Dec 19; 4:e31.
Published: December 19, 2012.
Competing Interests: The author has declared that no competing interests exist.
The book Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together by Peter A. Ubel, MD effectively makes the case that good medical decisions require empowered patients, clinicians prepared to support them and techniques to help them communicate. Better than any existing literature, this book highlights techniques and behaviors that clinicians must use to support the empowered patient, and suggests significant improvements to decision aids.
The book is informative, comprehensive, and accessible. It is an important resource for clinicians and patients who want to learn ways to better communicate to each other in making health care/medical decisions.
The first part of the book, “The Rise of the Empowered Patient,” presents the history of medical decision making — starting with ancient Greece and Hippocrates, continuing with the ethics of experimentation of the mid 20th century, and concluding with a detailed account of the seeds of the empowered patient movement starting in the 60s.
In the second part, “Empowerment Failure,” the author describes various communication barriers caused by the use of medical jargon: giving different meanings to common words, misreading of emotions, and the difficulty of interpreting the research data. The author also presents methods for informing the patient and helping them understand research findings — with patient stories of success and failure with similar procedures/treatments.
In the third part of the book, “From Empowerment to Partnership,” the author uses behavioral economics to postulate an ethical way to present medical decisions to patients. It requires correct information, presented in a clear and balanced way with adequate support to make the decision process simpler for the patient.
In the fourth part of the book, “Learning to Share,” we are presented with situations in which patient empowerment and knowledge are not sufficient to make decisions. At the same time, physicians need to be educated to accept and support empowered patients. The author used his family’s experience in dealing with breast cancer to show how even patient empowerment and information, medical literacy and assertiveness are not in themselves adequate to be able to make decisions easily. This part also resonated with my experience in which physicians need to embrace the patient empowerment for it to work well.
In the addendum, “Eight Tips to Help You and Your Doctor Make Better Decisions Together,” the author summarizes the main ideas of the book in an easy guide for the patient. It is a handy checklist to be used to improve the relationship with a medical professional.
The book is written in an easy conversational tone. Each chapter builds on the previous chapters, extending the perspective and summarizing the ideas. It is captivating enough that it can be read as a leisure book, but it’s still packed with information.
As a patient, this book was very informative and useful in how it presents the advantages and challenges of medical decision making. It is an excellent background for any patient who would like to learn more about the patient empowerment movement, shared decision making aids, and their advantages and challenges.
The book is also useful to clinicians. The author presents many personal examples from his own medical practice, and clinicians will relate to the situations described. The bibliography is extensive and it includes references to studies or experiments used in the book. However, the author mentions it is selective, so researchers should not treat it as exhaustive.
- Ubel PA. Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. New York: Harper Collins; 2012.↩
Copyright: © 2012 Ileana Balcu. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.