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DOWNLOAD Shared Decision Making and Role Clarification Potentials in Medicine by Jerry A. Green, JD

Abstract: Four models of decision making distinguish shared decision making from informed consent.

Principles of collaborative planning for varying decisionmaking according to thevalues and preferences of patients and physicians are defined and discussed.

The values and risks of allocating responsibility by express agreement are discussed.

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Medical Decisionmaking Institute


Two cornerstones of the health care contract are scope of practice and how the parties allocate responsibility for making decisions. 

 Every doctor practices with a combination of implied and express agreements reflecting his or her own preferences for assuming responsibility and ability to define roles clearly.


 "The interpersonal process is the vehicle by which technical care is implemented and on which its success depends." Avedis Donabedian, MD, MPH

"Doctor-patient agreements can clarify how consent is understood and used." Laurens White, MD CMA Past President 

"Greater patient involvement in decisionmaking is essential, not only to the malpractice crisis, but also to the larger goal of optimal resource allocation." Patricia Danzon, PhD, University of Pennsylvania, Medical Malpractice: Theory, Evidence & Public Policy

"It is very difficult to fashion public standards, be they judicial or legislative, that function better than the contractual rules they replace. There are elaborate agreements for common purchases of household goods; we need explicit agreements now for medical practice." Richard Epstein, LLB University of Chicago, Medical Malpractice: The Case for Contract (1976)

"I am fortunate to have found Mr. Green, who is a fruitful source of ideas on successfully structuring health care practice. In an educational format, he is unusually talented in explaining these ideas. He listens to client concerns, analyzes them cogently, and suggests approaches succinctly and effectively." K. Lee Peifer, Heath Care Attorney, Albuquerque, NM

 "Your professional education at Grand Rounds in Obstetrics and Gynecoloy at UCSF was extremely enlightening and very effective in defining the various roles played by each person."  Edward C. Hill, M.D., Professor Emeritus

 "Mr. Green presented a fascinating program at the California Society for Healthcare Risk Management's Annual Education Program. All attendees showed great interest, and the Board of Directors of CHSRM were uniform in their praise of the refreshing presentation." Mark Cohen, ARM, RPLU, Director & Risk Management Consultant

Related Articles:

Epstein, R. Medical malpractice: the case for contract, AmBar Found. Res.J 1976,1, 87 The initial description of how areas of law governed by quasi-contract, and by implied or espress contract principles evolve over time from common law tort principles.

Epstein, R. Contracting out of the medical malpractice crisis. Persp. in Biol. and Med. Winter 1977, 228 A restatement of the premises with a broader view towards social policy implications.

President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research, Making health care decisions: The ethical and legal implications of informed consent in the patient-prcatitioner relationship. Washington DC, USGPO 1982. Observed difficulties with the informed consent doctrine, and identified shared decisionmaking as the ideal which a sound doctrine of informed consent should support. Suggested that shared decisionmaking replace informed consent, and that the needed change should not be expected from courts.

Articles by Jerry A. Green, J.D.

Minimizing Malpractice Risks by Role Clarification: The Confusing Transition from Tort to Contract, Annals of Int Med 109/3: 234-241, 8/1/88 DOWNLOAD this article.

Written for physicians, this piece discusses the difficulties with informed consent identified by a President's Commission in 1982 and their suggestion that shared decisionmaking be employed by the profession. It postulates the scope of practice and the allocation of responsibility for decisions as common misunderstandings capable of clarification and identifies the four basic decisionmaking models. 

Shared Planning: A New Foundation for Quality Criteria, Physician Executive 5/89

This article explains shared decisionmaking and collaborative planning for physicians involved in health care management and discuses the premises of the Annals article. 

Compliers, Consenters, Collaborators & Deciders: Know Your Patient's Decision-Making Preferences Medical Malpractice Prevention 9/91 WMCO

Risk management view of premises addressed in Annals article of 1988, highlighting medical decisionmaking models and illustrating physician patient agreements in clinical application. 

Collaborative physician-patient planning and professional liability; opening the legal door to unconventional medicine ; Advances in Mind Body Medicine, Volume 15, No.2, Spring, '99

Explores role clarification and collaborative planning as applied to the scope of practice boundaries between conventional medicine and holistic therapies. Contains a forum of comments by Ruth Cohn Bolletino, PhD, Tracy W. Gaudet, MD, Theodore Pincus, MD, David Studdert, LLB, ScD, MPH, on ethical questions, implications for acute and chronic illness, licensing and consent, and replies by the author.

Shared Decision Making and Role Clarification Potentials in Medicine Mediate.com, April 2008
Decision making patterns are studied according to four models that distinguish shared decisionmaking from informed consent. 


Medical Conference Presentations                                         by Jerry Green

UCSF/Harvard Pilgrim Health, National Education Conference                                    San Diego

Kaiser Permanente Hospital Grand Rounds                                                            Santa Rosa

U. of California Obstetrics Grand Rounds                                                              San Francisco

Cal. Soc. for Healthcare Risk Managers (CSHRM)Annual Meeting                                Berkeley

Medical Board of California Colloquium                                                                San Diego

Barristers' Health Law Committee, S.F. Bar Association                                           San Francisco                                                     

Cambridge Health Resources, Complementary Medicine                                            San Diego                                   

Innovision/Alternative Therapies Annual Conference                                                 Orlando                 

NMHCC Integrating Alternative Medicine & Managed Care                                      San Francisco

Alta Bates Medical Center Grand Rounds                                                                Berkeley

Health Care Administrators                                                                                 Pomona

Philadelphia Academy of Family Physicians                                                             Philadelphia

Sante Health System, Keynote: Nuts & Bolts of Managed Care                                    Fresno

Ethix Development Corporation / Health Data Research                                             Portland

Health Devices Research Institute                                                                         Redwood City

Blue Shield Medical Directors of Northern California                                                   Berkeley

Blue Shield Medical Directors of Southern California                                                  Pasadena

University of California Extension Program for Managed Care                                      Berkeley

University of California at Santa Cruz Extension                                                      Santa Cruz

University of San Diego                                                                                    San Diego

Southern California Utilization Management Conference                                            Long Beach

Rand Corporation Medical Committee                                                                   Santa Monica

California Association of HMOs (CAHMO) Annual Conference                                    San Francisco                 

American College of Utilization Review Physicians Certification                                  San Francisco

Family Medicine Conference: Power of the Art                                                        Kauai                                                     

St. Lukes Medical Center Grand Rounds                                                               San Francisco

Pacific Presbyterian Medical Center Department of Medicine                                     San Francisco

Marin County Chamber of Commerce                                                                  San Rafael

University of California Surgical Grand Rounds                                                      San Francisco

Childrens Hospital Grand Rounds                                                                          San Francisco

Pacific Presbyterian Medical Center Grand Rounds                                                      San Francisco

Obstetrical Anesthesia-1987                  UCSF Medical Center                                    San Francisco

Medical Educators Committee UCSF/ Pacific Presbyterian Hospital                     San Francisco

California Board of Medical Quality Assurance 2052 Committee                                    San Francisco

Collaborative Health Program, The San Francisco Consortium                                      San Francisco


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