Shared Decision-Making Is Harder Than We Admit

Most surgeons believe they practice shared decision-making. Most patients would disagree.

The uncomfortable middle ground is where the real work happens — and where training falls short.

Shared decision-making is one of those concepts that everyone endorses and almost nobody does well. In residency, we learn to present options and obtain informed consent. But there's a vast difference between listing risks and benefits in a pre-operative visit and genuinely helping a patient navigate a decision that will affect the rest of their life.

The challenge isn't knowledge — it's communication under uncertainty. How do you explain that a surgery has a 70% chance of improving their pain without implying a 30% chance of making it worse? How do you honor a patient's preference to avoid surgery when you believe surgery is clearly indicated? How do you slow down enough to listen when there are twelve more patients in clinic?

Real shared decision-making requires time, humility, and a willingness to sit with ambiguity. It means sometimes saying 'I don't know' and sometimes saying 'I wouldn't do this surgery on my own family member.' It means treating the conversation as part of the care, not a hurdle before the care.

We don't train for this. We should.