What Is Shared Decision Making in Medicine?
A clear explanation of shared decision making, how patients and doctors make medical choices together, and why this process improves care.
When the Decision Is Not Obvious
A patient arrives with a severe headache and mild neck stiffness.
One possible test is a lumbar puncture, a procedure where doctors collect fluid from around the spinal cord to look for infection such as meningitis. The test can be very helpful, but it also has risks and side effects.
Years ago, a doctor might have simply ordered the test. Today, the conversation often looks different. The doctor explains the risks and benefits. The patient asks questions. Together they decide what the next step should be. This approach is called shared decision making.
What Shared Decision Making Means
Shared decision making is a process where doctors and patients make medical choices together.
The doctor brings medical knowledge, clinical experience, and an understanding of the risks and benefits of different options. The patient brings their own values, preferences, and tolerance for risk.
Instead of the doctor making every decision alone, both sides participate in choosing the plan. The goal is to create a thoughtful decision that reflects both medical evidence and the patient’s priorities.
Why Medicine Has Moved Toward This Approach
Medicine used to be more paternalistic.
Doctors often made decisions independently because they believed it was the safest and most efficient way to deliver care. Their intention was to help patients quickly and confidently.
But over time, medicine recognized that patients should play an active role in decisions about their own bodies and treatments. Giving patients a voice improves trust, communication, and satisfaction with care. When patients understand the reasoning behind a plan, they are also more likely to follow through with treatment and follow-up.
Situations Where Shared Decisions Matter Most
Shared decision making is especially important when there is more than one reasonable option.
For example, a patient with possible stroke symptoms may qualify for clot-busting medication that can improve recovery but also carries a small risk of bleeding in the brain. Doctors explain the benefits and risks, and the patient helps decide whether to proceed.
Other situations include decisions about imaging tests, hospital admission versus outpatient follow-up, or whether to perform certain procedures. In these cases, the best choice often depends not only on medical facts but also on the patient’s comfort with risk.
The Balance Between Guidance and Choice
Shared decision making does not mean the doctor steps back completely.
Doctors still guide the conversation and offer recommendations based on training and experience. The goal is not to place the entire burden of decision making on the patient.
Instead, it is a partnership. The physician explains the situation clearly, outlines the options, and helps the patient arrive at a safe and informed choice.
THE BOTTOM LINE
• Shared decision making allows doctors and patients to choose medical treatments together
• The doctor provides medical expertise while the patient contributes their values and preferences
• This approach improves trust, understanding, and participation in medical care
By Dr. Karim Ali, Emergency Physician