72 Chapter 4 This example demonstrates how hard it is to predict what impact certain treatment modalities have. However, eliciting patient wishes and truly knowing what is important in a patient’s life might help the doctor picturing how the chosen treatment influences a patient afterward and so improve SDM before initiating this treatment. The so-called’ complication meeting’ was one example of how the department explicitly incorporated patient perspective. It was a meeting where a specific complication that occurred to a patient was analyzed. The affected patient was present at this meeting and had the opportunity to elaborate on her experiences. Next, healthcare professionals analyzed the incident and arranged improvements in patient care to prevent future harm. This dedication to doing well for patients was also visible at other times. Apart from first encounter visits, the doctors generally knew and cared about patients’ well-being and social situation. After initial treatment, they showed great attention to patients’ wishes, needs, and struggles in daily life. We observed many doctors openly reflect on their own thoughts and emotions and the dreadful consequences of patients’ severe illnesses. They seemed dedicated to guiding their patients the best they could, both medically and in other aspects of life, and they put in extra effort to do so. “Sometimes I call the general practitioner (of a patient) to tell him about the medical situation and to ask: ‘You know this lady better than I do. This is the situation; how can I best deal with this?’” (Source: interview with a gynecological oncologist) Discussion Statement of principal findings This study describes three elements in doctors’ habitus that might affect how SDM is handled. These elements are the strong emphasis on medical evidence in decision making, the fact that doctors present themselves in their conversations with patients as a whole team instead of as individual doctors and that doctors seem to act on what they think is best for patients instead of primarily informing themselves on what patients truly want and need. In the following section, the authors will reflect on those elements. Why do doctors emphasize medical evidence instead of focusing on individual patients’ needs first? One reason might be the rise of EBM, which has profoundly changed medicine since its origin some 25 or more years ago. However, the way EBM is used in this study setting is not in line with the initial idea behind EBM. Sackett et al. already explained in 1996 that EBM not only consists of the best ‘external medical evidence’ obtained from systematic research but also of the “identification and passionate use of individual patients’ predicaments, rights, and preferences” (p.71). [27] So, from this perspective, EBM is not merely about applying medical evidence, but it requires doctors to adjust this evidence to individual patient situations. In the current study setting, this frequently seemed to be lacking, especially in group specialist
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