I support plenty of movements: better wages for superheroes, peace movements, movements towards the fridge; but I’ve got to tell you about a new movement I’m into, one that’s growing momentum:

It’s called "Shared decision-making", and it has the power (even more than I have) to improve return to work outcomes exponentially.

At its simplest level it means that the doctor and the patient make a decision about treatment together. To make it effective it means that the patient needs a comprehensive amount of information about the decision they are making, to enable them to make an informed choice.

Sound simple? It ain’t.

Making an informed choice means having a depth of knowledge, thinking about and exploring the issues, and that can’t be achieved by a five-minute discussion about the pros and cons of proceeding down a specific path.

At the moment there is a range of organisations, non-profits and research entities, looking at how this can be dealt with. Some have produced DVDs or videos for patients, which take them through the evidence, and then provide interviews from a range of people who’ve been in the similar situation.

There’s a nice example from the US, where patients who have had disk protrusion and are deciding whether to proceed with surgery or not, are presented with the facts and talk about their decisions. Four different patients in four different circumstances are interviewed - click on the video in the left column.

What a wealth of information and what a wonderful resource for patients. The decision to proceed with spinal surgery is a major one, not everyone does well and some people get worse.

Some people wished they hadn’t had the surgery. Being comfortable with the decision made is important, and patient expectations can in fact alter outcomes.

In this area patients are sometimes told they will never be able to return to heavy work, or never be able to return to their normal job. Doctors might not always realise that the consequences for the patient of this seemingly simple statement are huge.

Does the doctor making the statement understand the implications for the patient? We know that the health outcomes of the people who are put off work are worse, on virtually every score.

They might lose their job, marriages break down and self-esteem suffers.

It’s important to remember that not all doctors are superheroes like yours truly – and if doctors aren’t able to get the picture themselves, how can they be expected to inform the patient?

We need resources to inform patients. We need interviews with people who’ve done well, to hear what it is that’s made a difference in their case.

How have they done well at managing their back problem? How have they done well at getting around their shoulder problem? How have they done well with dealing with workplace issues and how have they overcome the obstacles of returning to work after being off for a medium to long-term period?

People lose their confidence when they’ve been off work for a while. We ought to think about what we can give them to increase their sense that they’ll cope with the situation and return to work.

Problem solving is a job big enough for everyone to be involved in.

Shared decision-making makes experiences more worthwhile. A problem shared is a problem halved, but a solution shared is a solution doubled.