Shared Decision Making

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In his bestselling book Being Mortal, author Dr. Atul Gawande describes two models of how physicians have traditionally chosen to relate to patients. The first is a more paternalistic approach where the medical authority, who of course is seeking what is best for the patient, simply tells them what to do.  “’Take the red pill.  It will be good for you.’  We might tell you about the blue pill; but then again, we might not.  We tell you what we believe you need to know.  We have the critical knowledge and experience.  We make the critical choices.”

The second type of relationship is described as “informative.” The Doctor’s role is to supply the up-to-date knowledge and to skillfully execute the actions required.  The patient is responsible for making the decisions.  As medicine becomes more specialized and care givers focus on narrower and narrower areas, they know less about their patients but know far more about the technical aspects of their profession.  This process can work very well, if the choices are clear cut and the trade-offs are straightforward.  In fact, this is an easier roll for the professional, because in some ways they are relieved of the responsibility for the outcome.

In reality, neither model is what patients….or financial planning clients….want.  Yes, they want information and control, but they also want guidance.  Unfortunately, life gets in the way and most often there are non-financial factors which come into play.  Couples have different goals and fears about possible options.  Children, parents, neighbors, friends and others may try to influence decisions or may be affected by those decisions.  And, even after the decision is made, who helps coach the client through the process, offering encouragement and gentle corrections?

This style of relationship has been labeled shared decision making.  The roll of the Wealth Manager is to help the client determine what they want.  “What is most important to you?”  “What are your concerns?”  “Who else will be affected by your decisions and how do you feel about that?” Then, when you have fully determined what clients say they want, and why they desire it, you are in a position to offer alternatives.  As Gawande points out, when acting in the patient’s (client’s) best interest, “…it may be necessary to deliberate with people on their larger goals, to even challenge them to rethink ill-considered priorities and beliefs.”

Developing client relationships like this, where you are not just a subject matter expert, but also a trusted “thinking partner” takes time, skill and determination.  Isn’t this the kind of relationship you wish you and your family had with professionals you rely upon?  Aren’t there times you wished you had someone to help with shared decision making?  Someone who would coach you through your doubts and low energy periods?

Let’s suppose you have the determination to move your practice in this direction.  Time is a zero sum game.  If you are going to “take time” to work on training yourself, it has to come from not spending time doing something else.  If you are going to devote more time to developing closer relationships with clients, what are you deciding to stop doing?  If you want to learn new techniques, new people skills, perhaps we can help you find the right sources.

Pinnacle Advisor Solutions is all about sharing resources with a trusted, non-equity partner, so new goals can be met.  We would love to learn where you want to take your firm and your life.  Give us a call!

About the Author

Peter McGratty CFAPeter is co-founder and Vice President of Strategic Partnerships of Pinnacle Advisor Solutions and is also the author of From the Corner Office.View all posts by Peter McGratty CFA →

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