What is Shared Decision Making and How Does It Apply to Climbing, Backpacking, and Camping?

“Shared decision making” is a concept from healthcare. It is the practice of a clinician (often a doctor) and a patient having a conversation in order to determine the course of treatment for a patient.

Sounds basic, right? But it really didn’t used to be that way. In the medical field, there is often a pronounced information inequity. The clinician has been to school for many years to become an expert on the particular form of medicine the patient needs. The clinician has treated countless - thousands - of patients with similar issues. The patient is often completely new to the issue. Their personal experience may be their only experience with the problem or need. Basically, you have an expert and a novice. What used to happen was that the doctor would dictate treatment.

The movement towards shared decision making came about because of two realities: 1) the clinician may know the illness, but the patient knows the particular experience of the illness - a doctor can’t climb inside a patient’s body; and 2) the doctor’s goals and the patient’s aren’t always the same. The classic example of this may be end-of-life care. A patient may want dignity and reduced pain along with as much intact cogitative ability as possible. A clinician who isn’t listening may only be trying to extend life. The doctor can’t know that the patient’s mind feels fuzzy and that it is emotionally distressing to this one, particular individual. The doctor can’t know the patient’s goals.

…unless they have a conversation.

And this is the analogy to the backcountry, where it can often be the case that one member of a group has far more experience and knowhow than other members of the group. Should this expert person be able to dictate next steps to the rest of the group? No. The expert may have final decision rights, but the group needs to be consulted.

Motivation counts for a lot in the outdoors. We take on activities that are uncomfortable and exhausting. Will you get a better level of participation from someone who has been consulted and understands the reasons why the group is doing this or that or from someone who is told what to do… who isn’t asked what their goals are… who isn’t asked what they are experiencing?

As I mention in the video, one of the most common subjective hazards that contribute to avalanche fatalities is the “expert halo.” Everyone in the group defers to the most experienced person and don’t voice their concerns about the snowpack danger. Also as I mention in the video, the medical outcomes actually improve when an injured adventurer is consulted and made as active a participant as their injuries allow when someone needs to be evacuated.

In short, things get done better, with less person-to-person friction, and end up with better outcomes when a group collectively participates in discussions about choices… particularly when things go wrong. That doesn’t mean that the weight of an opinion from someone who has never been off the couch should count as much as the opinion of the certified guide. But it does mean that the person off the couch has as much right to have their goals understood (“I still want to make the summit if it’s safe,” or “I just want to go home, my mind’s a mess”) and their experience validated as anyone else. When we do include people in understanding what we are going to do and why, they “come into the boat and help row rather than be the current against the boat.” And that helps everybody.