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. Author manuscript; available in PMC: 2019 Oct 1.
Published in final edited form as: Acad Emerg Med. 2018 Jul 19;25(10):1118–1128. doi: 10.1111/acem.13499
In this example, the doctor has talked to you and examined you and believes there are two reasonable options regarding TESTS (like CT scans or ultrasounds) for you. There are potential harms and benefits to each option, like radiation to your body or how fast the test could be done. Your doctor can describe the potential harms and benefits of the options to you. What best describes your preference… (Check only one)

  • 1 □ I prefer to make decisions about which tests I will have.

  • 2 □ I prefer to make decisions about which tests I will have, after seriously considering my doctor’s opinion.

  • 3 □ I prefer that my doctor and I share responsibility for deciding which tests I will have.

  • 4 □ I prefer that my doctor make the decisions about which tests I will have after hearing and considering my input and opinions.

  • 5 □ I prefer to leave all decisions regarding tests to my doctor.