When is a shared decision not (quite) a shared decision? Negotiating preferences in a general practice encounter

We consider whether there are situations in which ‘shared decision makingʹ in primary care is inherently problematic, such as in the demand for antibiotics to treat viral disorders. In such an instance there might be a lack of the equipoise necessary for a decision-making context in which apparent choices are genuine options. Using the techniques of discourse analysis on the transcript of a consultation with the parents of an infant with tonsillitis, we illustrate how a general practitionerʹs (GPʹs) efforts to reach a ‘shared decisionʹ come unstuck through a combination of the embedded power imbalance and the conflict between the GPʹs own prescription preferences and those of the parent.