Shared decision making: a consultation for a common condition

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Doctor: Well, you have moderate osteoarthritis of the knees, which is common as people get older. It’s often referred to as ‘wear-and-tear-arthritis’. The usual course is for this condition to fluctuate – get better or worse – but with a slow progression over the years or decades. How is it currently troubling you?

Patient: Well, if I overdo things, my knees get quite painful and can stay that way for hours and make sleeping difficult. Recently, the pain has got worse, and I was worried I would need a knee replacement.

Doctor: Knee replacement is certainly an option but we usually reserve that for when simpler measures have failed.

Patient: So what else can you suggest?

Doctor: Well, simple analgesics or anti-inflammatory drugs can help manage the pain. Other than drugs, some special exercises to strengthen the muscles around the knee can help maintain function and decrease the pain. Would you like to know more about those?

Patient: Those drugs upset my stomach, so I’d like to hear more about the exercises.

Doctor: Fine. I’ll give you a handout that explains some of the exercises, but also get you to see our physiotherapist. Meanwhile, you can safely take paracetamol regularly for the pain and stay active.

Patient: That’s helpful, but aren’t there more treatment options?

Doctor: There are further options available for severe osteoarthritis. But at this stage you could well find that you will experience a steady improvement as you build up the muscles with the exercises, sleep better because you have less pain, and can generally do more. You might also consider going swimming, or walking the dog more often, which will not only strengthen the muscles but should also help you ‘feel good’, and help to keep your weight in check into the bargain! I think we can safely leave considering more drastic options until we see how you get on with the exercises and the pain relief. But don’t hesitate to come back to me if you think you’re disappointed with progress.

Next: Questions about translating research evidence into practice