ABSTRACT
The idea of shared decision making is that we each bring different kinds of knowledge to the discussion. One great hope has been that many of deficits of communications in care would be made good by ‘shared decision making’ between doctors and patients. A review of recent literature on ‘concordance’ between doctors and patients, of shared decision making and of the use of decision aids, shows that there is still a structure of highly restrictive practices among healthcare professionals. Especially in the sharing of information and knowledge, including respect for the special knowledge which only patients can bring to the situation. Conclusions from an oversight of much of this research on concordance – and on decision-making aids to support its development – suggest that a purchasing structure dominated by GPs will not make sufficient progress in empowering patients. Meanwhile, much of the difficulty embedded in the deficits of shared decision making arises from the biomedical model.
