• Neurourology

In 2012, the UK's National Institute of Health and Care Excellence (NICE)1 stated that clinicians should ensure that: ‘Patients are actively involved in shared decision making and supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them’. The authors of this paper provide a useful means of giving information to patients, which is part of a process with complex technical and philosophical aspects, and suggest how clinicians should behave in the encounter.

What the authors describe is attractive. If patients could weigh up the information and apply it to their circumstances using a personalised information grid, then we clinicians could sit back and let them get on with it. But, let us explore this example further.

Patients come with baggage, including the understandable fear of scary brain surgery—which is a hurdle they have to overcome—rather than continuing medical treatment, which somehow seems easier, especially in the light of limited personal experience (Aunt Maude was never the same again after that unrelated brain operation). Of course, the decision is ultimately a contextualised and emotional one …