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 making' in primary care is inherently problematic, such as in the demand for antibi otics to treat viral disorders. In such an instance there might be a lack o f the equipoise necessary for a decision-making context in which apparent c hoices are genuine options. Using the techniques of discourse analysis on t he transcript of a consultation with the parents of an infant with tonsilli tis, we illustrate how a general practitioner's (GP's) efforts to reach a ' shared decision' come unstuck through a combination of the embedded power i mbalance and the conflict between the GP's own prescription preferences and those of the parent. (C) 1999 Elsevier Science Ltd. All rights reserved.