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: Informed Decision Making in Outpatient Practice : Time to Get Back to Basics : Clarence H. Braddock III, MD, MPH; Kelly A. Edwards, MA; Nicole M. Hasenberg,MPH; Tracy L. Laidley, MD, MPH; Wendy Levinson, MD : Context Many clinicians have called for an increased emphasis on the patient's role : in clinical decision making. However, little is known about the extent to which : physicians foster patient involvement in decision making, particularly in routine office : practice. : Objective To characterize the nature and completeness of informed decision making : in routine office visits of both primary care physicians and surgeons. : Design Cross-sectional descriptive evaluation of audiotaped office visits during 1993. : Setting and Participants A total of 1057 encounters among 59 primary care : physicians (general internists and family practitioners) and 65 general and orthopedic : surgeons; 2 to 12 patients were recruited from each physician's community-based : private office. : Main Outcome Measures Analysis of audiotaped patient-physician discussions for : elements of informed decision making, using criteria that varied with the level of : decision complexity: basic (eg, laboratory test), intermediate (eg, new medication), or : complex (eg, procedure). Criteria for basic decisions included discussion of the nature : of the decision and asking the patient to voice a preference; other categories had : criteria that were progressively more stringent. : Results The 1057 audiotaped encounters contained 3552 clinical decisions. Overall, : 9.0% of decisions met our definition of completeness for informed decision making. : Basic decisions were most often completely informed (17.2%), while no intermediate : decisions were completely informed, and only 1 (0.5%) complex decision was : completely informed. Among the elements of informed decision making, discussion of : the nature of the intervention occurred most frequently (71%) and assessment of : patient understanding least frequently (1.5%). : Conclusions Informed decision making among this group of primary care physicians : and surgeons was often incomplete. This deficit was present even when criteria for : informed decision making were tailored to expect less extensive discussion for : decisions of lower complexity. These findings signal the need for efforts to encourage : informed decision making in clinical practice. : JAMA. 1999;282:2313-2320 : http://jama.ama-assn.org/issues/v282n24/full/joc91394.html