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Presidential Reflections on the 25th Anniversary of the Society for Medical Decision Making

Compared to where we were in 1978, much more information is readily available to patients and clinicians, on the Internet, from widely available photocopying of printed materials, and via medical and health care newsletters aimed at the general public. As a result, patients (especially younger patients) seek a greater role in the decision process. Consequently, shared decision making has become more prominent in the doctor-patient relationship. SMDM is not directly responsible for most of these developments, but our writing and point of view have contributed to their content and influence. Two movements can be identified as offshoots or children of Medical Decision Making: Evidence-Based Medicine and Shared Decision Making. The shared decision making movement is clearly about bringing decision analytic insights to clinical decision-making situations in a practical, useful way. Many of its chief proponents have been active in this society for many years. Evidence-based medicine (EBM) pursued a more independent course. Part 1 of the early Clinical Epidemiology text of Sackett, Haynes, and Tugwell was an introductory textbook of decision analysis. Part 2 was about critical appraisal. As time went on, formal decision analysis was less front-and-center in EBM and critical appraisal of the literature became the focus that dominates texts in that field. But recently, central figures in that movement have argued that evidence alone is insufficient for decision making, at least in some cases, and that values and preferences have to be considered. At the same time, the recent Hunink-Glasziou text pays much more attention than did the early Weinstein-Fineberg text to searching the literature for