The problematic of decision-sharing: deconstructing 'cholesterol' in a clinical encounter

Health Expect. 2003 Sep;6(3):242-54. doi: 10.1046/j.1369-6513.2003.00245.x.


Shared decision-making is increasingly advocated as a means of interacting with patients but there is also a widely accepted view that many factors will militate against this ideal. While some patients may not wish to take on the responsibility of decision-making, it is also evident that many find it difficult to assimilate probabilities about future events and overestimate the likelihood of some outcomes, especially when terms such as 'stroke', 'bleeding' and 'heart attack' are used in consultation and bring with them emotional connotations and reactions. Under such circumstances, should clinicians portray risks as best they can, in the hope that even a marginally improved understanding will be an improvement on unilateral professional decision-making? Or, conversely, should they 'guide' the decision process, acting in a way that is known as 'professional agency'? Developing some perspectives put forward in recent work by the authors and applying it to a distinct clinical context, this paper will provide (i) a discourse analytic exploration of a single extended example from clinical practice employing aspects of Bakhtin's theory of dialogism, and (ii) a discussion and summary of what we can learn from this analysis in the context of shared decision-making and risk communication.

MeSH terms

  • Aged
  • Cholesterol / blood
  • Communication
  • Decision Making*
  • Female
  • Humans
  • Hypercholesterolemia / diagnosis
  • Hypercholesterolemia / physiopathology
  • Hypercholesterolemia / prevention & control
  • Office Visits
  • Patient Education as Topic
  • Patient Participation* / psychology
  • Physician-Patient Relations*
  • Probability
  • Risk Assessment*
  • United Kingdom


  • Cholesterol