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Professor Elwyn and co-authors highlight the power imbalance in the doctor-patient relationship, and the associated detriment on shared decision-making (SDM).1 In order to maximize appropriate utilization of resources for patient-enablement, greater emphasis is necessary that SDM is relevant only in preference sensitive situations i.e. when there is equipoise about two or more treatments. Clearly, if there one, definite, “best” treatment there is no role for SDM. Secondly, even in preference-sensitive situations, doctors should make recommendations to enhance the patient’s decision-making ability. Recommendations form an integral part of the theory of SDM,2 and do not infringe patient-autonomy.3
1. Joseph-Williams N, Edwards A, Elwyn G. Power imbalance prevents shared decision making. BMJ 2014;348:g3178
2. Charles C, Gafni A, Whelan T. Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Social Science & Medicine 1999;49(5):651-61.
3. Faden RR, Beauchamp T. A History and Theory of Informed Consent. 1 ed. New York: Oxford University Press, 1986. pp 259.
No competing interests
22 May 2014
Abeezar Ismail Sarela
Consultant Upper GI Surgeon
Leeds Teaching Hospitals NHS Trust & School of Law, University of Leeds