VIDEO: Shared decision-making between patient, provider vital part of contraceptive care

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When patients come in and they want to talk about birth control, one of my biggest recommendations is that we engage in a process that is sometimes called shared decision-making. And in this process, the power dynamic that typically plays out between doctor and patient is flattened because what we are doing is acknowledging that this person is the expert in their own life. And so, it isn’t for me to communicate a degree of information, you to agree or disagree and then move on. But instead to have a conversation to co-create the kind of future that you’re trying to build. And one way to do that is through contraceptive care and decision-making. It certainly is not the only way, but for many folks that is a priority. So shared decision-making means really being open and understanding that communication is a two-way street. It isn’t just me as the doctor with the medical training and the scientific background telling you what you should be doing, but instead eliciting from the patient, what is it that you’re seeking? What are your needs and preferences? What are your desires in this conversation and at the point when you leave this office, and how can I, in my position, support you achieve those goals? We’ve really seen this go awry in the past with the history of medicine, and one way that we’ve seen it shown up is in coercive contraceptive care. Health care providers deciding, well, this person really shouldn’t have any more kids, we’re going to recommend this method above all. Sometimes that method is sterilization, sometimes it’s long-acting methods, but that may or may not be what the person is actually seeking. Instead of listening to what the person wants, we move forward with our own agenda.

Shared decision-making is the polar opposite of that. Our patients are leading the conversation. That isn’t to say that sometimes we don’t get patients who just want to know, what do you think I should do? And if that is the way the conversation goes, we respond accordingly. But most often, the patients that we’re caring for are coming in because they want a more expansive conversation. They want to gather information, and they may or may not leave this visit having made a decision, and that is OK too. Giving folks time and space to be able to make these decisions is a critical part of shared decision-making, and abandoning our own individual agenda in favor of meeting the needs of the person in front of us is key.