124 Chapter 7 yet to address is the competition SDM has faced from another major innovation introduced around the same time SDM emerged: EBM. EBM’s appeal over SDM lies in its emphasis on (objective) medical evidence, while SDM places individual patients’ more intricate and subjective needs at its core. The preference for EBM appears more logical within the prevailing medical culture that values measurable and reproducible medical evidence. [14] This inclination toward quantitative scientific methodologies in medicine, coupled with the relative undervaluation of qualitative approaches, is deeply entrenched. To underscore the skepticism surrounding qualitative research in the medical field, consider the 2016 letter addressed to The BMJ, signed by seventy-six senior academics expressing their reservations about The BMJ’s limited emphasis on qualitative research. [47] This strong bias in favor of quantitative medical evidence substantially diminishes SDM’s prospects for success when pitted against the likes of EBM. Next, one must consider whether SDM qualifies as a ‘brilliant’ concept. Throughout this dissertation, the brilliance of SDM has been assessed by accentuating its significance and ethical imperatives. Simultaneously, we have illuminated its numerous drawbacks. While critiques of SDM are still relatively rare, they do surface in contemporary literature as well. For instance, esteemed researchers in the field, including Elwyn and colleagues, have now recognized the limitations of SDM in specific medical contexts. They describe critical situations in which individual preferences may be constrained or overridden, emphasizing the importance of judiciously applying SDM. In particular, SDM has limitations when broader societal interests precede individual wishes, when there is insufficient evidence of benefit, when decisional capacity is compromised, or when profound existential uncertainty looms. [48] Although these limitations described by Elwyn and colleagues are intriguing, we will not delve deeper into those particular scenarios and why SDM seems less appropriate in those instances. However, these examples raise legitimate questions about the brilliance of SDM within these particular contexts and suggest that alternative decision-making solutions sometimes may be more appropriate. Furthermore, it is crucial to focus beyond the downsides of previous failed implementations. Failure, when seen as a source of valuable insights and a catalyst for innovation, can set the stage for future successes. [49] Instead of perceiving failure as a setback, it should be examined to discern its root causes, as these same failures can offer instructive lessons to guide future (SDM) implementation initiatives. [49] One crucial and apparent lesson learned is that SDM should be perceived as something other than a 4-step approach for clinical encounters, an additional clinician task, or an add-on to current care models. [50] Instead, SDM should be regarded as the embodiment of a clinician’s virtue, a fundamental professional competency, meanwhile endorsing its inherent complexity. So, SDM might not be so brilliant after all, not in its practical applicability or suitability in all contexts. As asserted in the preceding paragraph, its brilliance might be more evident in SDM’s ethical imperative of earnestly striving to ‘do good’ for the patient.
RkJQdWJsaXNoZXIy MTk4NDMw