Shared Decision Making: The Good, the Bad or the Ugly?

Undoubtedly, you will have noticed that shared decision making is hot. In many countries, heralth policy makers, along with patient support organisations and physician assocations, promote shared decision making as the preferred method of making decisions in medical consultations, including those in paediatrics. In this lecture, I will discuss the principles of the shared decision making approach, along with the medical, ethical and scientific reasons to use it as the preferred decision making model (the “good”). I will also address its potential disadvantages and barriers to its use (the “bad”). We will talk about why many doctors, despite their best intentions, find it hard to make truly shared decisions with their patients. Based on scenarios from daily paediatric practice, I will illustrate how paediatricians can change their consultation approach to move towards shared decisions with patients and families. This could be viewed as the metaphor of the ugly duckling turning into a gracious swan. We can work towards shared decisions with our patients and their families, and thus improve not only their satisfaction, but also the quality of our care, treatment adherence, and our work satisfaction.