Introduction

Shared decision making between doctors and patients has become the norm in medical decision making. There are three good reasons why there has been a shift from the traditional paternalistic model to a more bilateral and patient-centered model. First, the nature of medical knowledge has changed. Better understanding of the natural history of disease led to situations in which doctors had knowledge about their patients’ illnesses before the patients themselves had any symptoms of disease. In those situations, doctors need to disclose the diagnosis and the risks of forgoing treatment. Second, many modern therapies are initially worse than the diseases they treat. Again, explanations are necessary to convince the patient that the short-term risks and side effects are worth it to achieve the long-term benefits. Finally, there is often no single best treatment. Reasonable people can disagree about whether they’d trade off a slight increase in the chance of long-term survival for a worse quality of life. All of these changes create a health care environment in which both doctors and patients have more information than they have ever had before. That information makes decisions more complex. This chapter introduces the chapters in this book by which clinicians and philosophers try to clarify, critique, and understand the concept of shared decision making. In doing so, they use terms like “labyrinth,” “overwhelming,” “uncertainty,” and “dread.” Shared decision making as an ideal is inspiring and empowering but also frightening and somewhat ambiguous. This book tries to help doctors and patients navigate the complexities.