Making Decisions or Enacting Shoulder Care? Challenging Assumptions About Matters of Concern in the Orthopaedic Shoulder Clinic.

Because of increasing pressure on healthcare resources in many countries, public health policies are increasingly occupied with how to optimise decision-making processes to ensure medical interventions are appropriate, necessary and aligned with the preferences and values of patients. One prominent example is the concept/model of shared decision-making (SDM) which target clinician-patient interactions in the clinic. Such public health goals raise renewed questions about what matters to people when seeking healthcare, which models such as SDM may not be able to fully account for. In this article, we draw on ethnographic fieldwork in two Danish shoulder clinics. We identify specific uncertainties as they manifest in guidelines and the clinic, and draw on pragmatist-inspired theory, to argue that decision-making emerges as interactional work in what has been conceptualised as the subjunctive mood, to make treatment proposals acceptable. In this process doubt and hope are inherent elements to be acknowledged and managed, rather than avoided. Thus, we argue that such pragmatist ideals are fundamental to shoulder care. Our findings call for an approach to clinical decision-making in research and policy that considers the everyday concerns of patients and clinicians as they seek to navigate highly uncertain terrains.