Marine pharmaceutical monitoring with POCIS: sampling rate uncertainty, and implications for regulation.

Has the term ‘shared decision making’ outlived its usefulness? […] Indeed the very use of the word ‘decision’ may be where we have gone wrong in this field. People shy away from decisions about complex issues, and words such as options, preferences, and values are from a lexicon that is unfamiliar to many, and frankly, tough to scope. The need for efficiency and prioritisation in healthcare increasingly demands certainty about what works and which treatments to . How clinical decisions are made is increasingly of interest to policy‐makers and others trying to ensure the right patients get the right treatment at the right time attempting to counter unnecessary medicalisation, avoiding needless risks and preventing healthcare that offers little value to patients (Pedersen ; Raft et al. ). Rational clinical decision‐making based on the best available evidence has long been seen as the core of effective biomedicine and care. At the same time, over the last four decades, clinical and public health literature has advocated for greater patient involvement in decision‐making to align medical decisions with patients' individual situations (Borders et al. ). Central to these efforts is the model of shared decision‐making (SDM), a concept first used in the U.S. during the 1980s. It has since been incorporated into policy‐making, insurance systems and healthcare organisations, and is gaining increasing momentum worldwide. Specifically, in Denmark, SDM manifests in a large research centre devoted to implementing conceptual and political decisions in all five administrative regions of the healthcare system (Dahl Steffensen et al. ). SDM can take many forms. It is sometimes explicated as an approach to care (Montori et al. ) and other times as a model for decision‐making that can be evidence‐based (Dahl Steffensen et al. ). Despite various interpretations, there is general consensus that SDM remains difficult to implement, and its achievements are ambiguous (Elwyn et al. ). The problem has been suggested to be one of organisation, with a need for more robust conceptual frameworks. However, as Elwyn and colleagues suggest in the introductory quote, the fundamental problem might be with the terminology. In this article we demonstrate how SDM fails to fully capture the unfolding meaning of interactions. Drawing on ethnographic material from shoulder clinics, we explore what matters to those involved in clinical surgical consultations. In line with bioethicist Jonathan Ives, we suggest that SDM and its related concepts may not be totally honest about, or helpful, in understanding what is happening in the clinic, and what matters to both patients and clinicians (Ives et al. ).