This thesis examines shared decision-making at Vejle Hospital, Orthpodic Surgery Outpatient Clinic. Shared decision-making is a model where doctor and patient are seen as collaborators. The doctor must take the patient’s preferences and life situation into consideration and the patient must participate actively in order to make shared decision-making happen in the consultation.

The aim is to investigate how a doctor and patient come to an agreement about the patient’s further treatment and what relational conditions between the patient and doctor that might affect the decision-making process. We followed seven doctors and observed 29 consultations between doctor and patient. The analysis results in a set of patterns and deviations that we discovered in our empirical material.

We used a qualitative approach to obtain our material. We observed the consultations and recorded them with a tape recorder. We applied observation to attain a comprehensive insight into the relationship between the doctor and patient. We interviewed the patient and doctor after the consultation and asked about their immediate experience of the consultation.

The thesis takes a social constructivist approach to understand the relational conditions between the doctor and patient and how they come to an agreement. We have as a theoretical framework used discourse psychology in order to locate discourse patterns and deviations in our empirical material. We have drawn on positioning theory because it can enlighten us about how a doctor and patient position themselves in relation to each other. We have as an analytic tool incorporated speech act theory because it can give us knowledge about the participants’ statements.

The result of the analysis shows four different ways in which a doctor and patient may make a decision: 1) The doctor can, based on professional knowledge, make the decision without actively including the patient. 2) The doctor can recommend different treatments and leave it up to the patient to decide which treatment to follow. 3) The patient asks for a specific treatment and the doctor accommodates the request. 4) The last decision-making type is related to the third, but instead of accommodating the treatment, the doctor declines it. We furthermore detected different relational conditions that could affect the decision-making process. We found that: asymmetric knowledge, asymmetric power balance, trust, empathic abilities, different perspective and needs between the doctor and patient influenced the decision-making.

We did not detect shared decision-making in its pure form, and the above patterns lead to a discussion of whether or not shared decision-making can exist in practice. We believe that the model has some qualified elements that can help improve the doctor-patient relationship, but the model also faces some challenges in practice. Many barriers are potentially modifiable and can be addressed by attitudinal changes at the levels of patient, healthcare team and the organization.