Recent years have seen increasing emphasis on the patient role in decision making and a move away from the traditional paternalistic medical model.¹ In 1980 a Medline search identified 213 papers with the MESH heading of “decision making”. By 2000 this had risen to 2508 papers.

In 1993 a report of a working party on appropriateness of patient care in QHC recognised the importance of effective information exchange with patients and the central importance of patient preferences in the choice of appropriate interventions—that is, appropriateness is not purely defined by technical elements of quality such as effectiveness, but also by patient values and perceptions.² Furthermore, there …