Many arthritis patients eventually reach a difficult decision point.
Questions start to emerge:
- Should I continue conservative care?
- Do I need an injection?
- Is surgery the next step?
- Should I push through symptoms?
- Am I waiting too long?
- Am I rushing too quickly?
These are not trivial decisions.
And they rarely have one universally correct answer.
This is where shared decision-making becomes important.
What Is Shared Decision-Making?
Shared decision-making means treatment decisions are made through informed collaboration between patient and clinician.
This does not mean:
- the clinician simply tells the patient what to do
or - the patient is left to decide alone after reading the internet
Instead, it means combining:
- clinical evidence
- diagnosis
- risks
- options
- patient goals
- function
- preferences
- practical realities
Good decisions require both medical judgment and patient context.
Why Arthritis Decisions Are Rarely Simple
Arthritis care often involves multiple legitimate options.
Examples:
- education
- pacing
- exercise
- rehabilitation
- weight management
- symptom support strategies
- injections
- surgery
- broader conservative care pathways
Different patients may reasonably choose differently.
Because circumstances differ.
The Same MRI Does Not Mean The Same Decision
Two patients may have similar imaging findings.
But very different lives.
Example:
Patient A:
- walks 5 km comfortably
- sleeps well
- mild inconvenience
Patient B:
- cannot manage stairs
- poor sleep
- work limitation
- repeated flares
Same scan.
Different clinical reality.
This is why imaging alone should not dictate treatment.
The Osteoarthritis Research Society International (OARSI) supports individualised osteoarthritis management based on symptoms, function, and broader context rather than imaging alone.
Function Matters More Than Labels
The practical questions often matter more than diagnosis wording:
- Can you walk?
- Can you manage stairs?
- Is sleep affected?
- Is work affected?
- Are daily activities restricted?
- Has confidence collapsed?
A diagnosis label helps.
But function often drives decisions.
Risk Tolerance Differs Between Patients
Some patients strongly prefer conservative care.
Others prioritise:
- faster symptom relief
- reduced uncertainty
- procedural intervention
- avoiding prolonged limitation
Neither approach is automatically wrong.
Decision-making must align with realistic evidence and patient priorities.
Shared Decision-Making Does NOT Mean “Anything Goes”
Important clarification.
Shared decision-making is not simply:
“The patient wants it, so we do it.”
Evidence still matters.
Diagnosis still matters.
Risk still matters.
Suitability still matters.
Patient preference matters—but within clinically appropriate boundaries.
The National Institute for Health and Care Excellence (NICE) strongly supports shared decision-making as a core principle of musculoskeletal care.
Why Fear Distorts Decisions
Pain changes decision-making.
Patients may become frightened by:
- MRI wording
- “bone-on-bone” language
- fear of worsening damage
- surgery anxiety
- internet horror stories
- prior bad experiences
Fear may push patients toward:
- rushed escalation
or - avoidance of appropriate care
Good decision-making requires context—not panic.
Why Internet Advice Creates Confusion
Patients commonly encounter conflicting advice:
- “Never get surgery.”
- “You must operate before it worsens.”
- “Injections are amazing.”
- “Injections are pointless.”
- “Exercise fixes everything.”
- “Rest completely.”
These contradictions create understandable confusion.
Shared decision-making helps personalise the discussion.
Common Misunderstandings
“The doctor should just tell me what to do.”
Not always.
Patient goals matter.
“Patient preference is all that matters.”
No.
Evidence and clinical judgment matter too.
“MRI determines treatment.”
No.
“There is one correct treatment path.”
Not necessarily.
What This Means For Patients
Useful practical questions include:
- What is the actual diagnosis?
- What are my realistic options?
- What are the likely trade-offs?
- What matters most to me functionally?
- What risks matter in my situation?
- Are my expectations realistic?
The better question is:
“What treatment path best fits my diagnosis, evidence, and real-life priorities?”
Practical Decision-Making Considerations
Considerations may include:
- diagnosis confidence
- function
- walking tolerance
- stair ability
- sleep
- work demands
- symptom burden
- treatment goals
- evidence
- risk tolerance
- patient preference
Based on over 20 years of clinical practice, Dr Terence Tan, founder of The Pain Relief Clinic Singapore, notes that patients sometimes search intensely for the “best treatment,” when the more clinically useful question is often which evidence-based option best aligns with the patient’s diagnosis, function, priorities, and practical tolerance for trade-offs.
When Further Assessment May Matter
Further review may be particularly important when:
- diagnosis remains unclear
- treatment decisions feel rushed
- symptoms escalate unexpectedly
- surgery is being considered
- MRI findings are frightening
- prior treatment repeatedly failed
- patient goals are unclear
Frequently Asked Questions
What is shared decision-making?
Collaborative treatment planning between clinician and patient using evidence and patient context.
Does shared decision-making mean patients choose everything?
No.
Clinical appropriateness still matters.
Does MRI determine treatment?
No.
It informs—but does not dictate—decision-making.
Is there always one correct arthritis treatment?
No.
Context matters.
Should patient preference matter?
Yes.
Within evidence-based clinical decision-making.
Is surgery always the next step when conservative care fails?
Not automatically.
Why do different doctors suggest different things?
Because interpretation, context, and patient priorities differ.
About the contributor
Dr Terence Tan is a Singapore licensed medical doctor with over 20 years of clinical practice and founder of The Pain Relief Clinic Singapore (https://painrelief.com.sg).
Medical Disclaimer
This article is for educational purposes only and does not constitute personalised medical advice, diagnosis, or treatment recommendations. Individual medical decisions should be made in consultation with an appropriately licensed healthcare professional.
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