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Monday, August 15, 2011

Shared decision making requires shared responsibilities, not knowledge

According to the Journal of the American Medical Association, 46% of adults cannot understand the Label on their prescription medications (see http://www.readfaster.com/education_stats.asp). The average reading level of adults in this country is commonly reported to be 8th grade.

Take those facts into account and then read this tweet.

@Skepticscalpel: How can a patient, who does not know what meds she is on or why, seriously participate in "Shared Decision Making"?

"The same way a doc who doesn't know the difference between a web browser and a mail client uses his computer" I responded.

"@Skepticscalpel: @motorcycle_guy But the doc isn't putting his care & possibly life in danger by not knowing" is the quick response.

The risks are irrelevant. The notion that one must be technically proficient to participate in decision making is a misconception stongly held by technologists of all kinds. While we'd certainly like for it to be true, it often isn't (remember the stats cited above).

As a software developer, it is often my job to make a complex set of issues readily understandable to a stakeholder who doesn't have the neccessary background to infer consequences of the decisions they must make. My responsibility is to make it clear, theirs is to make their needs known. Together, we decide on a best course forward. If we do a good job, everyone feels good. It is a shared responsibility. I cannot blame the customer for my failure to explain the repurcussions of their choices.

After all, if they understood it as well a I did, they wouldn't need me in the first place.

People are much more complicated than computers or software. I expect the professionals that serve and service them to be much more skilled at this than I am. But perhaps I ask too much.


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