The vast variety of choices we can make about so many aspects of life has become something that our grandparents could hardly have dreamed of.

Twenty-five years ago, someone wanting an overseas holiday would have gone into a travel agency, selected a brochure, and bought a holiday with all the essential elements packaged together.

Over the past few days, I’ve just spent more hours than I care to calculate trying to put together a holiday from scratch.

The choices seemed infinite – which airline to take, which car hire firm to use, which hotel to stay in, which online site might have the best choices, which reviews I could trust … It was exhausting.

The tyranny of choice meant that each and every one of these decisions might turn out to have been the wrong one. There were times when I was wishing I could have handed the whole thing over to a travel agent. Then I would have someone else to blame if the holiday went badly.

It reminded me of the many occasions in my career when my patients felt confused by the management options on offer – whether about medication, or surgery, or any  number of other aspects of healthcare. They would simply say to me in desperation, ‘What would you do, doctor?’

I’m sure that’s a question that you’ve been asked many times.

Looking back, I now realise that I made a significant mistake in my responses. I thought I was being kind in recognising their dilemma, and by answering the ‘what would you do?’ question.

However, what I needed to know was much more about what mattered to them. Saying, ‘personally, I’d go for the surgery rather than the medication’ might be an accurate answer but it’s not helpful if you don’t understand your patient’s priorities.

Some years ago, Professor Al Mulley and colleagues wrote a wonderful paper for the King’s Fund on this topic entitled Patient preferences matter: stop the silent misdiagnosis.¹ It flagged up just how poor most doctors are at understanding our patients’ preferences. Mulley calls this ‘preference misdiagnosis.’ This is an aspect of practice that really does matter.

None of us would have thought about choosing a holiday by asking the travel agent, ‘where would you go?’ We understand that their likes and dislikes might be very different from ours.

How much more important is this in healthcare, where patients often feel all at sea when faced by complex, potentially life-changing decisions? ‘What would you do, doctor?’ is a question we should be very cautious about answering, without understanding a great deal about our patient’s health beliefs and priorities.

An absolute refusal to answer doesn’t help either – leaving our patients at risk of some of the nonsensical ‘advice’ that they may find on the internet.

A functioning, supportive, efficient health service absolutely needs GPs to have time to listen, question, support and care.

What do you think, doctor?