Patient-Physician Decision making 2020.

Let your patients take part in your decisions.

In the last few years we witness a change in Patient-physician relations and the exposure to websites and social media makes medical data much more available for the patients. the result of that is a real change in the way decision making is being made solely by the physician, something that happened much more back in the days where the only thing we had is the physician knowledge and some hard cover newspapers.

This new era brings by far more challenges to the physician that has to be very much updated and cannot rely on things he knows back from medical school cause than he will have to face a patient who might know more than him in the specific area.

This is all true for HIV in the new ERA where treated HIV is mostly not life threating anymore and your physician might not be your life saver anymore which you will follow for the good and the bad, but rather that someone who will tell you how can you live a long healthy life Living with HIV.

One of my most important messages whenever I am giving talks is that it is time to stop being so paternalistic about your patients and just invest time at  giving them the best knowledge and sources for a reliable objective materials to make the right decision for them.

If we take a look at the new HIV drugs available on the market the main things to discuss about are:

1.      Should I change my Regimen if everything is OK? Here it's your time as a physician to explain the pros and cons of switching and explaining that sometimes side effects are not shown if you don't look for them (bone density etc') but on the other hand no drug is perfect and the newer drugs might have some side effects too. In other words "If its not broken why fixing it" VS.  "I am always into changing to the newest Iphone there is"

2.      Choosing between the available regiems : Today HIV drugs will probably get you to the basic endpoint of being Undetected with a decent CD4 count and choosing one Regimen over the other should be done after introducing the patient with what's available and maybe even giving him some homework before making the decision. For example 2 drug regimen Vs. 3 drug regimen and issues like the chances of Weight gain, interactions and even the pill size should be addressed.

I feel that by making the patient feel he is part of your decision making with your help while giving him\her  an open ear to all questions while being very updated is the secret for living long life with HIV and being more adherent to their  regimens.

This approach is probably true for a lot of other chronic diseases that might have a lot of treatment options (Diabetes, Blood pressure etc')

Having said that it's always OK to help the patient make the decision if he feels he is not able to make one or don't want to and decide to trust you completely.