Shared Decision Making and Psychiatry During the Pandemic

choice medication Apr 28, 2020

I was on a call with a group of psychiatric care providers, many of whom were working with people via tele-psychiatry for the first time.  The subject of people getting labs done to screen for metabolic syndrome came up.  On the one hand, people on certain medications typically have bloodwork every 3-months to check for signs of metabolic syndrome.  On the other hand, in the midst of the COVID-19 pandemic, there are risks associated with going to a clinic or lab for a blood draw. Even having the blood drawn at home presents some level of risk for the individual, those they live with and the phlebotomist. 

Some of the psychiatric care providers felt it was too risky to order lab work for people at this time: "Ethically I can't justify writing a lab order".  I understand this perspective and how it reflects the ethical principle of beneficence.  However, whose decision is it to take this risk?

On the call, I reminded folks that it is not necessarily psychiatrists' prerogative to decide what acceptable risks are. This is a situation in which there is an ethical imperative for shared decision making. 

Here's what I think: In a psychiatric care consult, there are two experts in the room. In addition to the care provider, those of us who use medication are also experts. We are experts in what matters to us. We are the only ones who can apply our unique values to weigh the relative benefits and risks. We are the ones who must decide if taking the risk of exposing ourselves to the virus at the lab, is worth the risk of metabolic syndrome remaining undetected.

Decisions about having labs done during a pandemic are not just medical decisions. They are also deeply personal decisions. The role of the psychiatric care provider is to support our deliberation; our weighing of the benefits and risks. And yes, it is fine for us to ask what our provider's recommendation is. That can be important for our deliberation, too. And finally, if we were to decide that we wanted to have the blood draw, and if our care provider could not ethically write the order, then part of the shared decision making process would be to help us find another care provider who would be willing to order the labs.

When a course of action involves both benefits and risks, those of us who use meds must be involved in those decisions. That's what shared decision making is all about, even during a pandemic.