Shared Decision-Making

S hared decision-making (SDM) between physician and patient is an idea founded in ethics and the law and in some evidence of superior health outcomes. SDM is the practical reconciliation of respect for persons (autonomy) and the monopoly and power of physicians: a middle ground between "nanny-knows-best" paternalism and rampant consumerism. SDM includes the notion of a medical encounter as a "meeting of experts" -the physician as an expert in medicine and the patient as expert in his or her own life, values and circumstances The doc prescribes but the patient takes the pills (or doesn't). Trends in healthcare policy emphasize involvement of community and service users in many aspects of their care. Indeed, the popular enthusiasm of governments for self-care initiatives cannot be imagined without such involvement. However, authentic involvement surely requires participation in decision-making.