122 Chapter 7 The portrayed oversimplification of SDM has resulted in a loss of its core purpose. To counteract the prevailing reductionist tendencies in medicine, we must, at the very least, distill SDM to its true essence: genuinely understanding the patient when making a decision together. This understanding necessitates establishing a solid relationship between the clinician and the patient. [40] Indeed, this understanding may be the crux of SDM and a pivotal factor in a doctor’s commitment to ‘doing good’ for the patient. In the subsequent section, we will delve deeper into this concept of ‘doing good’ and delivering ‘good work’ as a doctor. Embracing the essence of ‘good work’ The concept of ‘good work’ within healthcare is often equated with delivering high-quality care, yet the definition of what constitutes high-quality care is open to debate. For instance, in 2019, a Dutch philosopher and a former gynecologist explored the concept of quality in healthcare. This endeavor revealed that quality in healthcare is not a singular, objective entity but rather a moral concept that cannot be exclusively anchored in empirical facts. [41] This perspective on quality diverges from the conventional medical paradigm, where quality is often quantified and compared. However, what defines quality in healthcare can vary significantly from one individual to another and can encompass different priorities for doctors and patients. [41] Hence, it is crucial to comprehend what professionals mean by delivering high-quality care, as it may substantially differ from predefined definitions or the measurement of healthcare outcomes. Moreover, the assumption that SDM automatically equates with delivering this high-quality care, as perceived by doctors, warrants further investigation. In our search to unravel the essence of ‘good work’, we encountered the ‘Good Project,’ an initiative that originated at Harvard and has made its way to the Netherlands. [42, 43] The ‘Good Project’ fosters ethical thinking and responsible behavior across various domains, including medicine. It delves into the meanings of ‘good work’ and ‘doing good’, with ‘good work‘ representing a set of core values guiding professional conduct and a professional’s sense of responsibility. Applying this concept of ‘good work’ to SDM and our study population, we recognize the clinicians’ willingness to do good for their patients. This commitment was particularly evident in the physicians’ habitus, one component of Bourdieu’s definition of physician culture in Chapter 4, [13] as physicians consistently strived to do their best for their patients. This dedication was also evident in interviews and conversations with study participants throughout all research projects incorporated in this thesis, as most clinicians openly considered SDM a crucial aspect of virtuous medical practice. However, aligning with these ‘good work’ principles offered by SDM sometimes seemed more complex, as depicted in both this thesis, where professionals did not consistently use SDM, and in previous research results. [44] The aforementioned reductionist approach might seem an appealing solution to doctors, as it equates SDM with straightforward procedural steps or the provision of a patient decision aid. This approach could alleviate the strain of executing SDM while enhancing the delivery of
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