When Making Health Care Decisions, Your Voice Matters

My patient “Valerie” comes to me with a decision to make: which birth control to use. As her ob-gyn, it’s my job to help her choose which method is right for her.

I know many things about Valerie: her age, height and weight, medical history, and so on. From our many conversations over the years, I also know she and her husband want to start a family but aren’t quite ready yet. For now, Valerie travels a lot for work, and she trains for triathlons in her free time.

When a doctor helps you make a decision, personal details like these are just as relevant as your medical history, if not more so. We consider your values and preferences along with the benefits and risks of the options in front of you.

The process of a doctor and patient having a conversation together is called “shared decision making.” Here’s what I want patients to know about this important way of communicating.

Two-Way Conversation

It’s easy to understand the ob-gyn’s role in the doctor-patient relationship. Your ob-gyn comes to the table with deep knowledge of women’s health care and the science behind medical recommendations. They also draw on their experience with treating past patients.

But as the patient, you have valuable information too. You know your culture, your family dynamics, and what’s going on in your life. You are the expert on what you want from your health care—why you’re sitting in that office right now. When these perspectives meet, you and your doctor can weigh everything together to help you make the best decision possible.

Shared decision making can apply to any aspect of women’s health care, but it’s most useful when there are two or more paths to consider. Here are just a few examples.

• Mammograms: For women with an average risk of breast cancer, we used to always recommend beginning mammogram screenings at age 40. But the benefits and risks are not the same for all patients. Women in their 40s are more likely to have false-positives—that is, mammograms showing possible signs of cancer when there really is none. This causes a lot of undue anxiety for some women. So that may be one reason to decide to delay mammograms until you are closer to 50, as long as you are not at increased risk of breast cancer and have no symptoms. We recommend starting mammograms no later than 50 if you don’t start in your 40s.

• Abnormal bleeding: We can treat abnormal vaginal bleeding with medication or surgery. Deciding starts with knowing how bothersome the symptoms are for you, and discussing which treatments typically have the least risk and the greatest benefit. We’ll also talk about your values and preferences. Do you wish to get pregnant one day? Are you wary of major surgery? If yes, medication might be a good place to start.

• Birth control: Each form of birth control comes with its own benefits, risks, level of effectiveness, and side effects. Are you trying to prevent pregnancy? Are you trying to manage menstrual bleeding? Do you mind thinking about your birth control every day? Variables like these make choosing birth control a classic area for shared decision making.

Circling back to Valerie: Her demanding schedule leaves little room for the unexpected, such as irregular periods. She told me she wasn’t happy with the IUD (intrauterine device) she had before. Together, we decided birth control pills are a good choice based on her current goals, routines, and lifestyle.

Setting the Tone

As an ob-gyn, it’s my role to establish a relationship with my patient at each visit. When I ask about family, career, hobbies, and social life, it’s more than just chitchat. It’s valuable input for the conversation we’re about to have.

So how do you know when shared decision making is happening? It might look like this:

1. Your doctor begins each visit with open-ended questions about your priorities, such as “What brings you in today,” and then listens to your concerns.

2. Your doctor asks about your values (what is most important to you about the decision to be made), your preferences, and your past experiences.

3. Your doctor gives you information that is easy to understand. You might get resources you can read, apps you can use, or videos you can watch to learn more.

4. You feel you fully understand all the options available to you.

5. Your doctor encourages you to ask questions.

6. You’ve had all your questions answered.

7. You and your doctor talk about any barriers to your care, such as financial difficulties or lack of transportation.

8. You are comfortable with your health care decisions.

9. You trust your doctor and feel satisfied with your health care experience.

No detail is too small to share with your ob-gyn. If you’ve ever started a comment with “This probably isn’t relevant, but…” I urge you to continue that thought. Everything you share helps us paint a complete picture of who you are as a person—information that’s helpful to know in the course of shared decision making.

You Have a Voice

You have an entire life outside of the doctor’s office. Your health care team wants to know about that life and where you’re coming from. When we partner to make decisions together, we provide the best care possible.

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.