Clinical priorities

The second reminder happened the next day, at the conference. A presenter was giving a paper summarizing the results of her PhD research on shared decision-making between doctors and patients with end-stage renal failure.124 She had discovered that the doctors she had researched were exclusively concerned with what she called ‘molecular management’ – with clinical concerns about co-morbidity, survival rates, scheduling dialysis according to clinical priorities, and so forth – whereas the patients were concerned about their quality of life – being able to go shopping and to spend time with their families, even if this meant going against some of the clinical priorities. Paradigm X concerns were making Paradigm Y possibilities invisible.