Shared decision making is a process where patients and clinicians collaborate to make healthcare decisions based on the best available evidence. Despite many clinicians believing they already use shared decision making, research shows a gap between perception and reality. This approach is important for ethical reasons, including respecting autonomy, balancing benefits and risks, and avoiding harm. It can reduce unnecessary procedures, improve equity, and lead to better health outcomes and lower litigation rates. Best practices for implementing shared decision making include using patient decision aids, such as pamphlets, videos, or web-based tools, which help patients understand treatment options and their potential benefits and harms. Tools like the Wiser Choices and option grids are designed for use in clinical encounters and help facilitate shared decisions without significantly increasing consultation times. Simple strategies for individual clinicians include creating awareness of equipoise, discussing the benefits and harms of each option, and inviting patients to participate in decision-making. Patients should be encouraged to ask questions about their treatment options, and clinicians should support them in the decision-making process. Shared decision making requires a partnership between patients and clinicians, with both sharing responsibility. It is important to involve patients in developing quality indicators, educating health professionals, and creating patient-centered services. Clinical practice guidelines can promote shared decision making by highlighting decision points and suggesting how to involve patients. Despite its benefits, shared decision making is not routine. Challenges include the need for more time, potential conflicts with guidelines, and concerns about its relevance to different patient groups. However, shared decision making is relevant to all patients, regardless of education or income level, and can be implemented in low-income settings with appropriate support. The implementation of shared decision making requires multifaceted strategies, including cultural change among professionals, their organizations, and patients. It should be seen as the core of good clinical practice, with patients at the center of all decisions.Shared decision making is a process where patients and clinicians collaborate to make healthcare decisions based on the best available evidence. Despite many clinicians believing they already use shared decision making, research shows a gap between perception and reality. This approach is important for ethical reasons, including respecting autonomy, balancing benefits and risks, and avoiding harm. It can reduce unnecessary procedures, improve equity, and lead to better health outcomes and lower litigation rates. Best practices for implementing shared decision making include using patient decision aids, such as pamphlets, videos, or web-based tools, which help patients understand treatment options and their potential benefits and harms. Tools like the Wiser Choices and option grids are designed for use in clinical encounters and help facilitate shared decisions without significantly increasing consultation times. Simple strategies for individual clinicians include creating awareness of equipoise, discussing the benefits and harms of each option, and inviting patients to participate in decision-making. Patients should be encouraged to ask questions about their treatment options, and clinicians should support them in the decision-making process. Shared decision making requires a partnership between patients and clinicians, with both sharing responsibility. It is important to involve patients in developing quality indicators, educating health professionals, and creating patient-centered services. Clinical practice guidelines can promote shared decision making by highlighting decision points and suggesting how to involve patients. Despite its benefits, shared decision making is not routine. Challenges include the need for more time, potential conflicts with guidelines, and concerns about its relevance to different patient groups. However, shared decision making is relevant to all patients, regardless of education or income level, and can be implemented in low-income settings with appropriate support. The implementation of shared decision making requires multifaceted strategies, including cultural change among professionals, their organizations, and patients. It should be seen as the core of good clinical practice, with patients at the center of all decisions.