Shared decision making is key to good patient care - GMC guidance

Effective decision making based on conversations between doctors and patients is fundamental to good care, according to guidance published today (Wednesday) by the General Medical Council (GMC).

New Decision making and consent guidance takes effect from Monday 9 November and follows extensive consultation with doctors, patient groups, health service employers and healthcare and legal experts.

The guidance will help doctors have meaningful conversations with patients about their treatment and care options, and is designed to be easy to follow, taking account of the pressures doctors are under at work.

There’s a single page summary with key principles doctors need to know, a focus on the importance of taking a proportionate approach, tailored to individual patients, and information on how healthcare colleagues can support decision making.

Professor Colin Melville, the GMC’s Medical Director and Director of Education and Standards, 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. Our guidance provides the key components of effective communication between doctors and patients, which are vital to help patients make decisions that are right for them.’

"Our guidance provides the key components of effective communication between doctors and patients, which are vital to help patients make decisions that are right for them."

Professor Colin Melville

GMC Medical Director and Director of Education and Standards

The updated guidance lists ‘seven principles’ of decision making and consent, including:

  • All patients have the right to be involved in decisions about their treatment and care, and to be supported to make informed decisions.
  • Decision making is an ongoing process focused on meaningful dialogue, based on the exchange of relevant information specific to the 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.
  • Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care. A patient can only be judged to lack capacity after assessment in line with legal requirements.

Professor Melville 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.’

Rachel Power, CEO of the Patients Association, said:

‘The Patients Association welcomes the latest guidance from the GMC. 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.’

Following today’s publication of Decision making and consent there is a six-week period, during which doctors should read and familiarise themselves with the guidance, before it comes into effect on Monday 9 November 2020.