Ian Hargraves, designer at the Ker Unit (Mayo Clinic), teaches a workshop on shared-decision making and its importance to achieve patient-centred care to first year medical students at Mayo. The idea of design sits just below the surface in the groups discussion of Shared Decision Making. Ian presents Shared Decision Making, not as a nice-to-have aesthetic veneer to be applied to care to bolster patient satisfaction or experience, but as integral to the work of medicine. For Ian, the involvement of patients and clinicians in Shared Decision Making is an appropriate response to the problems of illness in which there is no one clear or technically correct way forward. In these situations patients and clinicians must design a response that is best for this person and their situation. This work happens in design/care conversations. In conversation patients and clinicians move beyond diagnosis to discover the particular problems of this person’s illness, what might be done about them, and the reasons that they have to favor one course of action over another. For first year medical students, the discussion of Shared Decision Making focusses attention on the human interaction that is the basis of care rather than on the necessary but impersonal science that they will spend years acquiring.
Ian is also teaching a workshop to third year medical students. As part of the two week module student groups are tasked with designing a decision aid around a chosen issue such as alcohol treatment, domestic violence, chronic pain, infertility, or guns and depression. The students commonly begin by looking for information on their subject and strategies for communicating it to patients. The students quickly discover how limited the scientific knowledge on these problems and their treatments are. They also come to recognize that presenting information is only a small part of helping someone through their problem. The literature on alcohol for example provides a general picture of the problem of alcohol abuse, but for an individual patient it is important to draw out how alcohol plays in their life—what it positively contributes and what harms it does. Treatment must be tailored to a person and their life, not to a diagnosis of alcohol misuse. The students come to recognize that the thing that they’re designing—a decision aid, is supporting material for the human interaction in which patient and clinician talk, think, and feel their way through what’s wrong and what might be done.