So the model of EBM that we espouse is one grounded in the patient ‘dilemma’ being the start and end point of the process. You’ll recall it’s a patient’s situation that triggers the asking of a PICO question, and particularly the selection of patient-oriented outcomes are vitally important. The acquisition and appraisal of studies that follow link to this, then applying the results of your deliberations needs to bring those thoughts back to the patient and discussing where to go with it.

That discussion of where to go is the core of shared decision making.

My experience of shared decision making has evolved over my years of working in paediatric oncology. Most often, I’ve had conversations which are most shared and least guided when we’re talking about symptom-relieving approaches where a variety of near-equally effective options are open. (Next most often it’s in the situation of relapsing disease where a wide range of uncertainty in many dimensions appears.) For a massive range of not-yet-senior clinicians, the realms of non-life-saving interventions are where I would suggest you take a brave step into the world of shared decision making.

Really.

Actually.

Not EBM as a satisfying but ultimately brain stretching but pointless exercise but a fundamental way of practicing medicine. Why not take it up with the next young person you meet who doesn’t like their laxative, or family considering their new baby’s soft and uncannulated skin?

– Archi