An outcomes model of medical decision making

Abstract

In the traditional 'fix-it' model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.

Impact of a brief intervention on patient communication and barriers to pain management: Results from a randomized controlled trial

“…First, it is important for the clinician to elicit and address patients' misconceptions about pain and pain management as these can serve as barriers to obtaining adequate and appropriate pain management. Second, our results add to a substantial literature showing that physician communication styles characterized by openness and responsiveness may lead to improved patient outcomes [38,[42][43][44][45][46][47]. Such communication skills, however, do not develop by virtue of clinical experience alone; indeed, physicians not only benefit from specific training in this regard but a work environment that promotes relationship-centered patient care [48][49][50].…”

Patient-reported Limitations to Surgical Buy-in

“…This is not easy as physicians of all specialties struggle to learn what is important to patients, 17,18 and the prospect of high-risk surgery is inherently frightening. Lynn and DeGrazia recommend a technique that presents a range of possible outcomes—like stories in a series of books on a shelf 19 —including both the best possible outcome and the worst case scenario. 20,21 This can create a platform for discussion about what matters most to patients without implying that an undesirable outcome is destined to occur.…”

Clinical Momentum in the Intensive Care Unit. A Latent Contributor to Unwanted Care

“…In 1991, Lynn and DeGrazia described a related concept: the "fix-it" model of medical decision-making (26). In the fix-it model, illness is a deviation from "normal" form or function, and the role of medicine is the restoration of normalcy.…”

“…Yet, as Lynn and DeGrazia and others have recognized, this model is limited. The fix-it framework assumes that a return to normal is possible, when this outcome is rarely true for chronic or complex conditions (26,27,29,30,32). Furthermore, the fix-it model encourages patients, families, and physicians to consider abnormalities as isolated, correctable problems without acknowledging the broader context of a patient's health status (27,28).…”