Often, decisions in medicine are portrayed in black and white. From a patient’s perspective, one may seek the “answer” to a medical concern or question. Physicians are trained this way; in medical school, every board question has a single “correct” answer. Understandably, to an extent, the system must exist this way. At the end of the day, we must make a decision, and we must have a sense of an “answer” to these concerns and questions. Furthermore, in certain settings, especially urgent or acute, there needs to be a generally agreed upon “correct” decision based on scientific evidence to act quickly in time-sensitive situations. 

However, outside of these rare scenarios, actual clinical practice is far from this straightforward. Decisions are messy. There is ambiguity and uncertainty in most actions. At its very core, medical decision making is a balance of risks and benefits. We must always consider both as a physician-patient team. There is almost never a single “correct” path forward because no two patients are exactly the same. 

Enter “shared decision making.” This concept is based on working together as clinician and patient to find a path forward when faced with a medical challenge that has multiple potential solutions. A clinician will take into consideration that particular patient’s life story, preferences, previous health experiences, and tolerance for risk. For one patient, plan A may be the best. For another patient, plan B- even if we are discussing the same diagnosis and prognosis. 

Why? Because medicine is not a one-size-fits-all framework. The “art and science” of medicine has become a cliche, but there is still value in thinking in this way. A discussion of the risks and benefits may leave different patients feeling very differently about how to proceed forward in the same circumstance. The “science” can be thought of as the discussion of the available evidence or research surrounding a certain topic. It boils down to: “what do we know, and what do we still need to discover?” We talk about how the available science may or may not generalize to the particular patient at that moment in their life. The physician has an informed discussion with the patient based on current scientific understanding and the tools available. 

The “art” is arguably the most important part of shared decision making. A physician can offer advice on all the great scientifically grounded treatment options available, but what is the patient’s perspective? Have they tried those already? Do these treatment options’ benefits sound better than the risks for this patient? The “art” is making a personalized decision together that blends the scientific evidence with a course of action that feels right to the individual patient after they have had the chance to assimilate the information discussed. 

To carry out this process correctly is to be comprehensive, thorough, and honest; ultimately, it is extremely fulfilling for both physician and patient. A shared understanding of the physician’s and patient’s points of view allows for the decision on the best next course of action for the individual. It still may not be an easy decision, and that is okay. The process takes time. To be done correctly, it cannot be rushed. If we can make this process a priority, we find much better physician-patient relationships and better outcomes along the way. 

This leads to one of the most common questions that I face in clinical practice: “How can I help this patient in front of me right now understand their available treatment options, the risks, benefits, alternatives, and feel confident in the decision that they want to make for their health?” 

Ultimately, I see my job as a guide and educator. I want to help patients take ownership of their health decisions by being a trusted source for informed decision making. 

Some answers are black and white. Most are not. When it comes to decisions about long term health, it is worth taking the time needed to appropriately engage in shared decision making. This is the foundation of exceptional medical care.