Shared decision-making, which is a central theme in this project, is a key component of the vision of shifting power from clinicians to patients. The clinical encounter brings together two epistemic positions or knowledge domains: the patient's embodied experience, and the doctor's biomedical knowledge and technical expertise. In shared decision-making, both should be given equal respect.

According to NHS England, shared decision-making is supposed to ensure “that individuals are supported to make decisions that are right for them”. Through a collaborative process, the clinician must support patients to reach decisions about their treatment. The process involves bringing together the clinician’s expertise (such as treatment options, evidence, risks, and benefits), and what the patient knows best (their experiential knowledge, as well as their personal circumstances, goals, values, and beliefs). 

In 2011, the vision was articulated in a speech by the Secretary of State for Health, Andrew Lansley, with the catchphrase ‘No Decision About Me, Without Me'. He ended his speech with a vision of “…making the entire NHS a place where there truly is No Decision About Me, Without Me”. He also formulates the essence of this ideological shift: 

“Since the first days of modern medicine, when a doctor or other medical professional has spoken with their patient, it has tended to be quite a one sided affair. [...] The patient’s role has generally been rather passive. Providing information when asked for it and accepting the medical opinion offered. When it comes to the conversations that matter [...] I want it to become, as UCL’s Professor David Tuckett has called it, ´a meeting between two experts´.”

For shared decision-making to become an integral part of patient care, initiatives are needed across various areas, including policymaking, legal regulations, infrastructure, and education. The success of these initiatives depends on whether the intended cultural shift is evident in the day-to-day meetings between patients and clinicians.

By studying naturally occurring consultations between patients and GPs, our intention is to explore actual decision-making processes, including negotiations of epistemic positions, and identify factors supporting and obstructing this cultural shift.