Shared Decision-Making: Partnering With Patients

For most of medicine’s history, the model was paternalistic: the doctor decided, the patient complied. That model is fading for good reason. The best medical decisions, especially where there is genuine choice, uncertainty or trade-offs, are made with patients, not for them.

Shared decision-making is the practice of clinicians and patients making decisions together, combining the clinician’s medical expertise with the patient’s values, preferences and circumstances. It is not about abdicating clinical judgment or overwhelming patients with choices; it is about genuinely partnering with them. Done well, it improves the quality of care, builds trust, increases adherence and leaves patients more satisfied.

Why shared decision-making matters

• Better decisions. When decisions reflect both the medical evidence and the patient’s values, they are more likely to be the right decision for that person, which is not always the textbook default.
• Adherence. Patients who participate in a decision are far more likely to follow through on it. A plan a patient helped choose is a plan they own.
• Trust and satisfaction. Being treated as a partner rather than a passive recipient deepens the therapeutic relationship.
• Appropriate care. Shared decision-making often reduces low-value care, since informed patients frequently choose less-aggressive options than a default do-everything approach.
• Ethics. It respects patient autonomy, an ethical cornerstone of good care and the foundation of genuine informed consent.

When it matters most

Not every decision needs extended deliberation; some are clear-cut. Shared decision-making matters most when:

• There is genuine choice among reasonable options.
• There are meaningful trade-offs between benefits and risks, or competing priorities.
• The right choice depends heavily on the patient’s values: how they weigh quality against length of life, their risk tolerance, the lifestyle impact.
• There is genuine uncertainty in the evidence.

Preference-sensitive decisions, where the best choice genuinely depends on the individual, are exactly where partnering with the patient is essential.

How to practise it

Present the situation and the options honestly

Explain the situation and the realistic options, including, where relevant, the option of doing nothing or watchful waiting. Patients cannot participate in a decision whose options they do not understand.

Communicate risks and benefits clearly

Convey the benefits and risks of each option in a way the patient can actually grasp: plain language, meaningful numbers, no jargon. This ties directly to health literacy, since a decision based on information the patient did not understand is not shared.

Elicit the patient’s values

Ask what matters to them: their goals, concerns, and how they weigh the trade-offs. This is the part clinicians most often skip, and it is the heart of shared decision-making. The patient is the expert on their own values.

Deliberate together

Bring the medical expertise and the patient’s values together in a genuine conversation, working toward a decision that fits both. Guide without dictating.

Support the decision

Once decided, support the patient in acting on it, and revisit as circumstances change. A shared decision is not a one-time event but part of an ongoing relationship.

Balancing guidance and autonomy

A common worry is that shared decision-making means dumping every choice on patients and refusing to give an opinion, which most patients neither want nor benefit from. That is a misunderstanding. It does not mean withholding your expertise or recommendation; it means combining your expertise with the patient’s values.

Most patients want their clinician’s honest guidance and to have their own preferences genuinely heard and weighed. The skill is offering real expertise and, where appropriate, a recommendation, while remaining genuinely open to the patient’s values and choice. It is partnership, not abdication, and not paternalism either.

How your platform supports it

Shared decision-making is fundamentally a communication practice, but a few things support it. Good decision-support and patient-education resources help present options and risks clearly, and a complete view of the patient grounds the conversation in their actual situation. Crucially, it takes time, and time is exactly what ambient documentation can give back by reducing the burden that otherwise crowds these conversations out. When the clinician is present and talking rather than typing, there is room for the genuine deliberation this requires.

Frequently asked questions

What is shared decision-making?

Shared decision-making is clinicians and patients making medical decisions together, combining the clinician’s expertise with the patient’s values, preferences and circumstances. It replaces the old paternalistic model for decisions involving genuine choice, trade-offs or uncertainty. It is not about abdicating clinical judgment, it is about genuinely partnering with patients on decisions that affect their lives.

When is shared decision-making most important?

It matters most for preference-sensitive decisions: those with genuine choice among reasonable options, meaningful trade-offs between benefits and risks, heavy dependence on the patient’s own values, or real uncertainty in the evidence. Some decisions are clear-cut and do not need extended deliberation, but wherever the best choice genuinely depends on the individual, partnering with the patient is essential.

Does shared decision-making mean I cannot give my recommendation?

No, that is a common misunderstanding. It does not mean withholding your expertise or refusing to recommend; it means combining your expertise with the patient’s values. Most patients want their clinician’s honest guidance and to have their own preferences genuinely heard. The skill is offering real expertise, and a recommendation where appropriate, while staying open to the patient’s values and choice.