"Shared decision making can level health care disparities in our country and it's the ethically right thing to do," Moulton said.
Moulton defined shared decision making as an integrative process between the patient and clinician in which the patient is provided with information regarding all possible medical procedures. Although this definition is similar to that of informed consent, shared decision making "goes further" by incorporating patient preferences and values in medical plans, Moulton said.
"[Patients] make decisions in the face of avoidable ignorance and clinicians poorly diagnose patients' preferences," he said.
Shared decision making should only be implemented in non-emergency cases like when breast cancer is diagnosed in its early stages because the patient has multiple treatment options and adequate time to consider each one, he said.
Recent studies have found that an alarmingly high percentage of physicians favor administering medicine to their patients rather than discussing alternative treatment plans, according to Moulton.
"This is the Nike theory of practicing medicine just do it," he said.
Since there are many discrepancies between what patients and providers prioritize, medical treatment decisions should always be collaborative, according to Moulton.
Moulton questioned the "effectiveness and efficiency" of the U.S. health care system, since health insurance programs often limit patients' ability to execute their own health preferences, he said.
Medical decision-making standards vary from state to state approximately half of states use a "patient standard of care" while the other half rely on "a physician-based standard," he said. The former standard states that the patient must have all the information on risks, benefits and treatment alternatives that an "objective patient" should know, while the latter requires physicians to disclose information that other doctors would provide under similar circumstances, he said.
Moulton said he rejected both approaches, as there is no such thing as an "objective" patient and it is incorrect to assume that physicians across the country provide "a universal standard of care," he said.
A possible drawback to informed consent policies is that patients may regret their final decisions and subsequently sue their physicians, which is known as the "Dr. Merenstein Problem." Daniel Merenstein, a physician who helped patients make medical decisions, was sued by a patient who developed cancer over an "error of omission," Moulton said.
Due to their hectic schedules, physicians often do not have adequate time to explain various medical procedures to each individual patient, Moulton said. Despite such roadblocks, the benefits of shared decision making including greater patient comfort with decisions and more accurate risk diagnosis outweigh the possible risks, he said.
"If we have the ability to do something that's better for the patient and better for the physician, I think we should look long and hard at the possible changes," Moulton said.
Moulton praised institutes including the Center for Shared Decision Making at Dartmouth-Hitchcock Medical Center that are working to align patients' values and lifestyles with medical preferences.
"According to the Congressional Budget Office, we spent 14.9 of the [gross domestic product] on health care in 2005 and this figure is projected to rise to 50 percent in coming years," Moulton said. "That's not sustainable, especially since 20 to 30 percent of the $55-billion [health care budget] has had no impact on our health care system."
Although informed consent is relatively imbedded into the current health care system, Moulton said he is optimistic about encouraging shared decision making on the "national level." Minnesota has two bills pending that support shared decision making, and Washington, Vermont and Maine have already installed legislatively-mandated projects in their health care systems, he said. New Hampshire legislators seem interested in implementing such programs in the future, according to Moulton.
The lecture, titled "Rethinking Informed Consent The Case for Shared Decision Making," was the kick-off event of the College's annual Law Day celebration and was co-sponsored by the Rockefeller Center, the Dartmouth Lawyers Association, the Dartmouth Legal Studies Faculty and the Center for Health Care Delivery Science.
