When Is a Shared Decision Not (Quite) a Shared Decision? Negotiating Preferences in a General Practice Encounter
Social Science and Medicine. 1999 Aug; 49(4): 437-447.
We consider whether there are situations in which 'shared decision making' in primary care is inherently problematic, such as in the demand for antibiotics to treat viral disorders. In such an instance there might be a lack of the equipoise necessary for a decision-making context in which apparent choices are genuine options. Using the techniques of discourse analysis on the transcript of a consultation with the parents of an infant with tonsillitis, we illustrate how a general practitioner's (GP's) efforts to reach a 'shared decision' come unstuck through a combination of the embedded power imbalance and the conflict between the GP's own prescription preferences and those of the parent.
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Towards a Feasible Model for Shared Decision Making: Focus Group Study With General Practice Registrars Elwyn, Glyn; Edwards, Adrian; Gwyn, Richard; Grol, Richard (1999-09-18)OBJECTIVES: To explore the views of general practice registrars about involving patients in decisions and to assess the feasibility of using the shared decision making model by means of simulated general practice consultations. ...