GMC Updates Guidance on Doctor-Patient Shared Decision Making

Peter Russell

September 30, 2020

Doctors are being reminded that patients have the right to be involved in decisions about their treatment and care and to be supported to make informed decisions wherever possible.

Guidance published today by the General Medical Council (GMC) is designed to help doctors hold conversations with patients about their treatment and care options.

Prof Colin Melville, the GMC's medical director, said: "Doctors are working in pressured environments and in challenging circumstances, impacting on the time they have with patients. It is therefore critical their conversations with patients are meaningful, and that they support patients to make decisions that are right for them.

"Poor practice, such as failing to share information patients need to make informed decisions, can lead to poorer outcomes, more complaints and, in some cases, serious harm."

Decision Making and Consent

The updated guidance, Decision Making and Consent, lists seven principles. These are that:

  • All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able

  • Decision making is an ongoing process focused on meaningful dialogue, based on the exchange of relevant information specific to the individual patient

  • All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it

  • Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action

  • Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care

  • The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and decisions should be made in consultation with those who are close to them or advocating for them

  • Patients whose right to consent is affected by law should be supported to be involved in the decision-making process, and to exercise choice if possible

Prof Melville, who is also the GMC's director of education and standards, added: "Consent and shared decision making are at the heart of the doctor-patient relationship.

"Obtaining a patient’s consent need not be a formal, time-consuming process, but should be part of having good conversations.

"Our guidance sets out what is expected, and doctors should use their judgement about how to apply it depending on each patient's individual circumstances."

A 'Patient-centric Approach'

The Patients Association said it welcomed the updated guidance.

In a statement it said: "We are pleased to see this guidance start from the premise that informed consent remains a bedrock of the patient-doctor relationship and build on it to help doctors equip patients to take decisions. This includes ensuring that patients have the information and understanding to weigh up the consequences of different options.

"It has been a core tenet of the Patients Association for over 50 years that patients have rights and agency in respect of their care, and we believe that this guidance will help in embedding this patient-centric approach further within medical practice."

The guidance comes into effect on 9 November 2020.


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