Apple Podcasts 
Spotify Aug. 10, 2026
Episode 467: Making Shared Decision-Making Work with Dr. Aliza Ben-Zacharia and Linda Lachman
Key Takeaways
- Shared decision-making is a collaborative process where patients and clinicians work together to select tests, treatments, and care plans based on clinical evidence and personal values.
- Establishing mutual trust early in the doctor-patient relationship lays the essential groundwork for successful long-term management of multiple sclerosis.
- Patients who actively participate in shared decision-making experience greater feelings of empowerment and are more likely to adhere to their treatment plans.
- Effective communication requires clinicians to balance their medical expertise with the patient's lived experience, lifestyle preferences, and individual goals.
- Even with limited appointment times, clinicians can incrementally incorporate shared decision-making by prioritizing patient goals and open dialogue during visits.
If you Google the term "shared decision making", you'll find it defined as a collaborative process where patients and clinicians work together to select tests, treatments, and care plans based on clinical evidence and the patient's personal values and goals.
But shared decision-making isn't an automatic happy pill. It takes work, it takes discipline, and it takes a clear understanding of both the patient's and the clinician's roles. This week, Dr. Aliza Ben-Zacharia and Linda Lachman join me to share how shared decision-making has worked for them over the course of their longtime doctor-patient relationship, and how it can work for you.
We have a lot to talk about! Are you ready for RealTalk MS??!
This Week: We're taking a deep dive into shared decision-making :22
Dr. Aliza Ben-Zacharia and Linda Lachman discuss how they have made shared decision-making work, and what to do if it isn't working for you and your neurologist 2:39
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RealTalk MS Episode 467
Guests: Dr. Aliza Ben-Zacharia and Linda Lachman
Frequently Asked Questions
What is shared decision-making in multiple sclerosis care?
Shared decision-making is a collaborative process where the neurologist or nurse practitioner and the patient work together to make healthcare choices based on medical evidence and what matters most to the patient's lifestyle and goals.
How do Aliza Ben-Zacharia and Linda Lachman make shared decision-making work?
They build a long-term trusting relationship through open communication, mutual respect, listening to each other's perspectives, and treating the patient as an equal partner in managing a chronic illness.
Why is shared decision-making important for MS patients?
It helps patients move from being passive receivers of care to active participants, which increases treatment adherence and provides a sense of empowerment in managing a lifelong disease.
WEBVTT
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It's August 11th, and we have a lot to talk about.
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If you Google the term shared decision-making, you'll find it defined as a collaborative
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process where patients and clinicians work together to select tests,
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treatments, and care plans
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based on clinical evidence and the patient's personal values and goals.
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It relies on two main participants, the clinician who provides medical expertise
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while explaining risks and benefits, and the patient who shares their lifestyle
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preferences, values, and unique needs.
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But for some people living with MS, appointments with their neurologist are
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actually quite different because more than a few doctors still cling to an outdated
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model of healthcare delivery and patient care
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that puts the doctor on some sort of a pedestal,
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prescribing medications and issuing treatment plans as if they're edicts arriving
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with an accompanying lightning bolt from Mount Olympus.
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With access to information just a mouse click away, and Dr. ChatGPT answering
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more than 40,000 healthcare-related questions a day, people expect more.
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More details, more engagement, and more two-way communication from healthcare providers.
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You know, it seems logical that people are more likely to adhere to a treatment
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plan that they've helped to create.
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And patients who do participate in shared decision-making come away with this
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great feeling of empowerment as they become an active participant in their treatment
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instead of a passive receiver of that treatment.
00:01:55.820 --> 00:01:59.060
But shared decision-making isn't an automatic happy pill.
00:01:59.590 --> 00:02:04.250
It takes work, it takes discipline, and it takes a clear understanding of both
00:02:04.250 --> 00:02:06.260
the patient's and the clinician's roles,
00:02:07.260 --> 00:02:11.960
This week, Dr. Aliza Ben-Zacharia and Linda Lachman are joining me to share
00:02:11.960 --> 00:02:17.350
how shared decision-making has worked for them over the course of their long-time relationship.
00:02:18.060 --> 00:02:22.880
Dr. Ben-Zachariah is a nurse practitioner specializing in MS care in New York
00:02:22.880 --> 00:02:27.760
City, and Linda has lived with MS since being diagnosed in 2005.
00:02:28.460 --> 00:02:34.080
In a moment, we'll meet my guests, Dr. Elisa Ben-Zacharia and Linda Lackman.
00:02:38.900 --> 00:02:42.330
Shared decision-making occurs when a patient and their health care provider
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work together to make choices about care based on medical facts and the things
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that matter most to the patient.
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In shared decision-making, the patient is no longer a passive receiver of treatment.
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Instead, they become an active participant in their treatment,
00:02:58.930 --> 00:03:02.850
and that can make all the difference when it comes to adhering to that treatment
00:03:02.850 --> 00:03:07.900
plan and gaining a sense of empowerment when it comes to determining how you're
00:03:07.900 --> 00:03:09.780
going to manage living with MS.
00:03:10.550 --> 00:03:14.550
Joining me today are Dr. Elisa Ben-Zacharia and Linda Lachman.
00:03:15.310 --> 00:03:20.110
Dr. Ben-Zacharia is a nurse practitioner specializing in MS care in New York
00:03:20.110 --> 00:03:24.110
City, where she's also a full-time faculty member at Hunter College.
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Linda Lachman was the founder and president of Delphi Associates,
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a strategic marketing and market research firm.
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Linda's lived with MS since 2005, and Dr. Ben Zacharia has been Linda's MS
00:03:38.350 --> 00:03:40.570
healthcare provider for many years.
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Dr. Ben Zacharia, Linda, welcome to the podcast.
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Thank you.
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My first question is for both of you. You two have worked together for many years.
00:03:51.940 --> 00:03:56.110
So take us back to the early days of your clinical relationship.
00:03:56.650 --> 00:04:02.340
How did you first establish the baseline of trust needed for true shared decision-making?
00:04:02.930 --> 00:04:05.240
Dr. Ben-Zechariah, why don't we start with you?
00:04:05.740 --> 00:04:11.060
You're taking me so many years ago. I think it was probably immediately after,
00:04:12.160 --> 00:04:17.570
Linda was diagnosed, maybe early 2000, 2006. I think,
00:04:21.630 --> 00:04:27.240
as a nurse practitioner, I think perhaps my perspective is a bit different.
00:04:27.240 --> 00:04:34.640
And I think working together with a well-known team and a great team that I've learned so much from,
00:04:35.310 --> 00:04:42.690
I think getting to know patients, getting to know their family, listening to patients,
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having, of course, my spiel, too, as explaining the disease,
00:04:47.930 --> 00:04:51.060
the MS, as it was very new to Linda.
00:04:51.060 --> 00:04:55.760
And thinking about what is MS, what to perhaps expect from the disease,
00:04:56.130 --> 00:05:01.990
what is a relapse of MS. Back then, we dealt with many relapses because we didn't
00:05:01.990 --> 00:05:04.330
have as effective medication as we have now.
00:05:05.650 --> 00:05:09.860
Building that relationship, I've met Linda's husband.
00:05:10.690 --> 00:05:15.890
I haven't met Linda's son, but I know so much about Douglas that I think it's,
00:05:16.120 --> 00:05:20.280
I think it's becomes almost like a family, but I'm still the clinician.
00:05:20.530 --> 00:05:23.200
I'm still the person that guide the conversation.
00:05:23.500 --> 00:05:26.210
I'm still the person that explain about MS.
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I am the expert, but I think Linda had a lot to say, number one,
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from her point of view. What does MS mean to her?
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What do the symptoms mean to her, the sensory symptoms, the annoying right leg issues?
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So I think building that relationship, listening to each other.
00:05:48.210 --> 00:05:52.880
Me, again, as an expert in the field of MS, thinking about what is the best
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medication for Linda, working with her, thinking about the side effects,
00:05:57.740 --> 00:05:59.430
how to manage the side effects.
00:05:59.430 --> 00:06:05.300
And back then, of course, Linda was on an injectable on one of the platform medications.
00:06:05.640 --> 00:06:10.440
And I think troubleshooting the side effect, thinking about how to make life
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better, how to make quality of life good for people that we know the MS did
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not really have a cure and it's a chronic illness.
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And how can we overcome all different obstacles?
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So I think based on this relationship, each one of us, I guess, Linda, we earned trust.
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We had some very good trusting relationship, and I think that's what perhaps
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makes Linda stay in our practice and then join me in my independent private
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practice in New York City.
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So I think I can say all these, all different discussions about other issues
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too, about life, about New York City, about perhaps some politics.
00:06:55.380 --> 00:06:59.530
I think, but then again, going always back to the main thing,
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how can we make the life of any patients better dealing with MS,
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which is a chronic illness?
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Linda, what about you? How did you initially establish that baseline of trust
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that's needed for shared decision-making?
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Actually, not knowing I had the disease initially, when I was diagnosed,
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I went to a number of different places within the city.
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And at that time, there weren't many.
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So I was deciding based upon the doctors I met, what facilities were available,
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what they told me, basically, at which time
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I decided on Elisa Ben-Zakaria and Dr.
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Lublin, who were at Mount Sinai in New York, which was one of the premier MS centers at the time.
00:07:50.560 --> 00:07:53.810
And we took it from there is basically what happened. So
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it wasn't as maybe as hard a decision in that you didn't have that many to decide from 20 years ago.
00:08:07.190 --> 00:08:12.770
Linda, let me ask you, and maybe we should step back one step and instead of
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diving right in as we have, let me ask you, how do you define shared decision making?
00:08:18.810 --> 00:08:24.840
And what did Dr. Ben Zachariah do early on that signaled to you that your voice
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would be welcome in determining your care?
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Okay. I think shared decision-making in general means exchanging views,
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info, questions, et cetera, as a patient and as a provider.
00:08:41.720 --> 00:08:46.510
So it's the fact that the provider does not just talk and give you information,
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but you are part of the process, which up until I think very recently was not always done very often.
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And the fact that the center where Aliza was and where I initially started to
00:09:03.920 --> 00:09:08.970
get my care from was that way made it very important to me.
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It was also a center, a center where there were doctors, there were nurses,
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there were help in terms of nutritionists.
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There was a much larger approach to MS, not as one disease, but as a lifelong
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issue that you're going to have to make changes as life goes along, too.
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Dr. Ben Zacharia, as a nurse practitioner specializing in MS,
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you have deep clinical expertise.
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How do you mentally pivot during an appointment to ensure your specialized knowledge
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leaves room for Linda's expertise in her own body and lifestyle?
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I think that you learn it over time.
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I think in the beginning of my career, it wasn't probably intuitive because
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everyone learned the paternalistic approach. You know better. You are the expert in MS.
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You probably ought to tell patients what to do, how to do it,
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and et cetera, et cetera.
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So I think, but you learn over time that the best way is to allow a patient
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to voice and to be partner in the care because once.
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It's something that they think is appropriate and the right thing to do,
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the right choice for them is,
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they're more likely to do it. So I think you incorporate it together in the
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visit, in the follow-up visit.
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Sometimes it may be challenging. However, I think you try to start the visit
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by listening to patients because they come to see you.
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Any changes? What are your signs and symptoms? And you try to say,
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okay, let's perhaps do this. And thinking about, for example,
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if it's fatigue, which Linda often mentioned in the visit.
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So we try to see how can we manage it differently with non-pharmacological agents.
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That's something that's very important for Linda, for example.
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So I think you can do it in between. It's not that you leave room in the middle or in the end.
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It's a very good question. But I think you try to balance it out throughout the visit.
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You voice your things. You say, okay, my expertise is that we ought to do this
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and this And that perhaps includes some more exercise for the fatigue and build
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up some energy and then think about other things.
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So I think the main focus is to think about patients as partners throughout
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the visit and have some, and Linda just mentioned it, have exchange of opinion.
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Say, okay, and I think Linda respects the fact that I'm an expert in MS.
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She comes to see me because she would like to hear what I have to say.
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Same as we have done when we worked together with Dr. Lublin in the center.
00:11:59.900 --> 00:12:04.610
So I think patient commands to listen to us as experts, as you mentioned.
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But also would like to contribute to the discussion because they are fully partnered,
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fully active in that discussion.
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And I would say it's just, I don't know, I think it's sometimes hard to say
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how it comes to be in an action.
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It's just you say something and then the patient says something and Linda would
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say, okay, I think I ought to do this. And we come sometimes,
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You may compromise on certain things. You say, perhaps maybe wait on this medication.
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You're on so many other meds. Let's do something different.
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And I think Linda is always pro less medication rather than more.
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So I think it comes in between each moment of the visit.
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Now I think it's more intuitive to me that I think patients are my partners.
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They're almost equal partner. Although, again, I think we have the expertise,
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and I think we have to guide patients very often in the relation to the disease-modifying
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treatment for MS or symptom management of MS.
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But I think always to think that patients are an integral part of all the decisions
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that we make together in the center, hopefully to get the best outcome.
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It's gone on for so many years that, you know, you go to your doctor,
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your doctor knows what it is, and your doctor gives you their opinion.
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And I think the fact of sharing in terms of decision-making is relatively new.
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There have always been doctors, I guess, that felt that the patient had something to add.
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But there also have always been doctors who felt, you came to me,
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I'm the doctor, I'll tell you what to do.
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And I don't react well to that. So if I was in that kind of situation,
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I think I would look for another doctor.
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And I think some people do, especially since MS is a lifelong disease.
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You're going to be doing this for a long time. So you should feel comfortable
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in the situation to say what your issues are, what kinds of things you're experiencing
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that are different or that have just arisen.
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You have to feel, as I said, comfortable with your physician or your PA, whichever way.
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Linda, because MS symptoms can change and new disease-modifying therapies emerge,
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you've likely faced some treatment choices since 2005.
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Has there ever been a specific treatment or a lifestyle decision where you and
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Dr. Ben Zacharia didn't immediately see eye-to-eye?
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And if there has, how did it get resolved?
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Probably not. But I think I started with giving myself injections three times a week.
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I initially was having a problem with three times a week, and we had a discussion with Dr.
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Ben Zacharia, Dr. Lublin, et cetera, that it was too much for me to also
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be able to live my life with that much kind of medicine going in me on a weekly basis.
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And we resolved that issue and have resolved it over the years.
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But basically, I was lucky.
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They did always listen to me. They did always take my problems as well as my
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feelings about the subject into consideration, which I think is highly unusual.
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I hope it isn't unusual with a lifelong disease.
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Dr. Ben-Zacharia, I think you've actually started to answer my next question
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during our conversation.
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I'm curious, when you present treatment options to a patient who has lived with MS for over two decades,
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how do you frame the risks, the benefits, and the evidence-based data so that
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it's truly accessible and collaborative rather than simply prescriptive?
00:16:03.870 --> 00:16:10.830
I usually try to think about the disease-modifying treatment as categories.
00:16:11.730 --> 00:16:18.740
Because I think we have so many medications today, and it's exciting, although challenging.
00:16:19.530 --> 00:16:28.100
And I think we do have some biomarkers to fit patients into certain categories, but it's not.
00:16:28.100 --> 00:16:34.060
So we're not very, very close to precision medicine. But I think we're getting
00:16:34.060 --> 00:16:40.630
there. We have some new markers that can perhaps help us make decisions and guide patients.
00:16:41.030 --> 00:16:45.150
So when I presented the patient, I usually present it as categories.
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I do start with saying that there are some highly effective medications,
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and some medications have low effectiveness in MS.
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I start with the big pictures, and I try to see if patients are thinking about
00:17:04.750 --> 00:17:10.960
more the risks that are related to medications, disease-modifying treatment, or they are more.
00:17:12.540 --> 00:17:16.720
Thinking about the effectiveness, the efficacy as we talk in MS language.
00:17:17.530 --> 00:17:25.390
So I try to see what patients really are going towards, what their views of
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disease-modifying therapy and what their risk aversion or not aversion.
00:17:30.730 --> 00:17:33.190
So trying to really gauge patients.
00:17:34.230 --> 00:17:40.860
So first I start with the high efficacy, low efficacy, concerns that this medication
00:17:40.860 --> 00:17:44.470
have, trying to say the most...
00:17:45.950 --> 00:17:50.850
I guess, concerning side effects. I don't think at a visit you need to present
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all the side effects in the world of every medications.
00:17:54.050 --> 00:17:58.090
You will never find to finalize a visit if you'll do that.
00:17:59.060 --> 00:18:04.150
But so I do that as a first category. Then I go into the oral,
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the intravenous medications, and then I speak about the injectable.
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The injectable, I do separate between the platform that are available for many,
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many years and are fairly safe in MS. And then I separate the anti-CD20 casinta or fatumumab.
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So I try to talk to people, to patients about the categories,
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the risk associated with the categories.
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I try not to overwhelm patients.
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I sometimes do another visit to talk about it, to allow patients to think about
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it, unless there is an urgency of starting an immediately disease-modifying therapy.
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So I think it's important to give patients two pictures of what's available
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out there, some of the science and the evidence.
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I do speak briefly about the science and some of the studies that showed efficacy,
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and I give some numbers, percentage.
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I do say that some of these medications are not compared to each other, so it's hard to tell.
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Often, I start,
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any general overview, but to say honestly, if I, for example,
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think a patient will benefit from a high effectiveness of high efficacy drug,
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like an intravenous medications, I will limit the discussion perhaps,
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to two families or just to one and say this is my opinion.
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I think as an expert in MS, you ought to go on high efficacy.
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And I try to explain, this is related to the clinical presentations,
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your signs and symptoms that you came today to see me, and the findings on your films on the MRI.
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I can share with you the films if you'd like to see. I tell patients,
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most patients like to see the MRI. I explain the lesions on the MRI.
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So I will tell patients, I think you really will benefit from these medications.
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And if you'd like to hear about some others, in New York City,
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patients, to say, honestly, are very knowledgeable. They read.
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Sometimes they have misconception about the medication and the data,
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the scientific data of medication.
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So you need to just correct those misconceptions. But tell patients,
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