121 General discussion more comprehensible components. [31] This approach extends beyond research into medical education as well, aiding in unraveling the complexities of the human body and its functions by studying individual organs, tissues, cells, and molecules. Such simplification is essential for medical students and practitioners as they strive to grasp foundational concepts and establish a solid knowledge base. [32] When considering Bourdieu’s definition of culture, [13] outlined in Chapter 4, which includes the significant role of intellectual capital – encompassing the knowledge and skills that physicians acquire throughout their training and career – it becomes evident why physician culture tends to align with these reductionist tendencies. However, reductionism also comes with drawbacks. In medicine, it has led to an overemphasis on the physical and biological sciences addressing complex health issues, often side-lining vital psychosocial and existential aspects of human health during medical training. This imbalance leaves students with an oversimplified version of the intricate reality they will encounter in clinical practice, often at the expense of the ‘softer’ side of medicine. [32] The reductionist approach has also infiltrated teaching methods for complex professionalismrelated skills, such as SDM. While advocating for reflective practice, current medical education often leans towards less effective, reductionist feedback mechanisms instead, as touched upon in the previous section. [29, 33] These mechanisms may involve directive or instrumental instruction on specific procedures or provide ‘tips-and-tops’. Actual reflective practice, however, encompasses a broader spectrum of considerations and self-awareness, often neglected in practice. Similarly, the reductionist tendency is prevalent when physicians contemplate implementing SDM. SDM is frequently reduced to providing information on the benefits and risks of treatment options or the distribution of decision aids. [34] It is simplified into following the previously mentioned 4-step SDM approach, as depicted in Figure 1. [35] Even when following this 4-step approach, the more intricate and demanding aspects of SDM, particularly the last two steps involving actively listening to patients and adapting medical advice based on the patient’s unique context, often receive insufficient attention. [36, 37] This simplification of SDM might even be reminiscent of EBM, which is often reduced to “following the guideline”, overlooking the crucial component of adapting medical evidence to individual patients’ contexts, which is an explicit part of EBM’s definition as well. [38] However, neglecting the inherent complexity of EBM and SDM does not do justice to their essence and may even hamper the desired practice change. Indeed, incorporating a patient’s unique context into the consultation amplifies the complexity of both EBM and SDM. Clinicians are challenged to discern which aspects of a patient’s context are relevant to arriving at the most appropriate (shared) decision. [39] Moreover, they must confront their own barriers towards SDM, as exemplified in part II of this thesis – barriers they may often be unaware of. 7
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