Shared Medical Decision-Making: A Perspective from the Science of Complexity
DOI:
https://doi.org/10.51987/Rev.Hosp.Ital.B.Aires.v46i3.1319Keywords:
shared medical decisions, complexity, patient-centered care, complex systemsAbstract
Shared medical decision-making (SMD) represents an evolution from the traditional paternalistic model toward a more participatory approach, where the patient becomes an active agent in managing his/her own health, rather than a passive recipient. This transformation integrates not only scientific evidence but also the individuality of the patient: values, emotional, social, economic, and cultural context. Complexity, in turn, studies how patterns and unpredictable behaviors emerge from dynamic, non-linear interactions among multiple components of a system.
SDM is proposed as a complex intervention in the context of medical conditions. Deciding from this perspective recognizes that health problems are neither linear nor simple; they involve multiple variables, dynamic relationships, and uncertain outcomes. The choice, therefore, must emerge from an integrative process in which technical knowledge, clinical experience, expert judgment, intuition, and the patient’s personal values interact. SMD is not reducible to the mere sum of isolated knowledge, but to the synergistic interaction between participants.
The complexity-based approach strengthens the SMD process by incorporating tools such as shared mental models, simulations, feedback, and multidisciplinary analysis. These tools enable the visualization of scenarios, anticipation of consequences, and adaptation of strategies according to the patient's evolving condition.
Ultimately, considering SMD as complex interventions means deciding a course of action jointly, through a dynamic, human, and deeply contextual process.
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