Preference Diagnosis

Team Talk
Options talk
Decision talk

Resources
1. Stop the silent misdiagnosis Patient’s preferences matter Mullay.A, Trimble.C, Elwyn,G. BMJ 2012;345:e6572 17thNov.
2. Shared decision making: a model for clinical practice Elwyn.G et al J Gen Int Med 2012;27:1361-7

A medical diagnosis is important but a “preference diagnosis” is equally important as outlined by Mulley et al 1 from Dartmouth College in the USA.  A preference diagnosis is facilitated by  three steps of “team talk”, “option talk” and “decision talk” 2.  Mulley points out that a preference misdiagnosis is often a silent misdiagnosis and can be just as important as a medical misdiagnosis. He cites the example of a patient who had a mastectomy then regretted this for all her life because she could have had conservative treatment and kept her breast. 1

Team talk

Team talk is to help the patient understand the doctor and patient are working together as a team. “The doctor is an expert on medicine and the patient is the expert on his or her priorities” 1. The patient is also an expert on their past history, allergies and family history.

Option talk

Option talk is about the doctor presenting a list of “options with risks, benefits, and side effects of each” 1. The doctor collates “verbal and non verbal cues to help identify preferences” 1  www.optiongrid.co.uk may help. Consider sharing both the options for diagnosis as well as the options for treatment. This keeps the patient fully infomed and part of the team.

Decision talk

Decision talk is when the doctor summarises back to the patient their preferences to check if they are correct. The patient may already have stated their decision so this may be just to check and confirmation. Some patients may move quickly to this stage especially if the options are clear such as antibiotic for a definite skin infection.

1.       Stop the silent misdiagnosis Patient’s preferences matter Mullay.A, Trimble.C, Elwyn,G. BMJ 2012;345:e6572 17thNov.

2.       Shared decision making: a model for clinical practice Elwyn.G et al J Gen Int Med  2012;27:1361-7