In this post you can watch my keynote, “Patient-Led Shared Decision Making: The Red Dot and the Blue Dots,” (see video below) that I prepared for the 13th International Shared Decision Making (ISDM) Conference, hosted at Dartmouth College, USA, July 7, 2026 to July 10, 2026. From the conference website: “With the 2026 theme, ‘A Wider Lens,’ this year’s conference will bring together clinicians, researchers, patients, and policy leaders to expand our understanding of shared decision-making across specialties, care settings, and systems.”

Further down, you can read a summary of my talk.

Summary of my talk

I use my “dotto-graphic” to reframe how we can think about shared decision making: one red dot represents the single hour I spend each year in clinical care for my Parkinson’s; a field of 8,765 blue dots represents every other hour of the year, when I’m managing my condition on my own.

The talk moves through three parts.

Part 1: The red dot

First, I look at shared decision making as it’s currently defined and practiced, drawing on the newly published Oxford Textbook of Shared Decision Making in Healthcare, including the patient-perspective chapter I co-authored.

Part 2: The blue dots

Then I move into the blue dots with specific stories, splitting a medication dose, deciding to start using a rollator, identifying a missing pill by touch in the dark, to show the kind of practical wisdom patients develop that rarely makes it into the clinic.

Part 3: The whole picture

Finally, I argue that the gap between the red dot and the blue dots isn’t a communication problem but an epistemological one: healthcare is built to recognize scientific and craft knowledge, but has no framework for patient wisdom (phronesis).

I close by introducing my new research project, Chronic Knowledge, and the concept of meta-selfcare, and leave the audience with a question: if shared decision making is to mean something beyond the clinic walls, what would need to change in how we define decisions, sharing, and knowledge itself?

---

Here are links to the other posts in this series:

• My recorded keynote for ISDM2026
• “How can we trust patients’ knowledge when there are anti-vaxxers and science deniers?”
• “What’s your opinion on healthcare delivered patient education?”
• “Who takes responsibility if the new way of taking pills harms other patients?”
• “Is epistemic injustice equally distributed, or stratified?”
• “How could we elicit Chronic Knowledge during a consultation? What question would you want to be asked?”
• “Is shared decision making ready to see the blue dots?”