Most clinical decisions require considering trade-offs. For example, anticoagulation decreases strokes but requires close monitoring and increases bleeding. For patients to make an informed decision, they need to be advised of the pros and cons of each course of action, so they can decide which course is most likely to lead to the outcomes most important to them.

Notice how the clinician in these examples does aspects of the following steps in discussing trade-offs:

1. Start by talking about the potential for harm as well as benefit and frame the discussion as a way to make an informed decision.
2. Discuss most common benefits.
3. Discuss most common risks or burdens, invoking previous experience of the patient or friends/family if possible. It is often difficult for patients to weigh the relative importance of specific risks and benefits. Linking these risks and benefits to past experiences can make a theoretical discussion more concrete.

Take a minute to think about what worked well in this example and what can be done differently.

• “It’s important to talk about the benefits and risks, so you can make an informed decision.”
• “I’d recommend that we skip this, because with your overall health, it’s more likely to hurt you than help you.”

Walter LC, Schonberg MA. Screening mammography in older women: a review [systematic review]. JAMA. 2014; 311(13):1336-47.