Patient choice and narrative ethics.

Most doctors subscribe to the idea of offering patients a choice about their medical management: for example, choosing whether to start preventive treatment for a risk factor like hypertension, or deciding which hospital to go to for an operation. Of course, such choices may not be as straightforward as they seem. Doctors may give a steer by what they mention in terms of risks and benefits, and some patients prefer their doctors to make decisions for them anyway. In spite of this, engaging in dialogue about choice has become one of the hallmarks of good medical practice. The right to choose has become a central feature of medical consumerism. There are also whole areas of medical discourse and training – like patient-centred medicine and shared decision-making – that focus on the idea. As well as being able to help patients make decisions, doctors also need to offer choices of a different kind during the consultation: inviting people to choose what they want to talk about at any moment. Although the skills for doing this receive far less attention than those concerned with decision making, they may be even more important. Consider, for example, these two alternative versions of the same consultation: