Most people have had this experience: sitting in a doctor’s office, hearing a recommendation, and agreeing to proceed—often within minutes.
It seems like a simple, fact-based decision. But research shows that choices also depend on how the information is presented, who makes the recommendation, and how the person feels at the time. The way the diagnosis is explained, the options offered, and whether patients feel comfortable asking questions about what to choose.
To find out what this looks like in real care, I spoke with Mark P. Pietropaoli, MD, an orthopedic surgeon with more than 25 years of experience, interviewed me about how clinical recommendations and how they are delivered determine patient decisions.
How Options Shape Choices
In medical visits, the way options are presented shapes what patients choose. Doctors set this “framework”—what is said, what is left out, and how choices are described. This is not manipulation; it is part of the clinical examination. But it has real consequences.
Research shows that people make different decisions depending on how the same information is presented. For example, A a systematic review found that framing consistently changes medical treatment choices, even when the clinical evidence is the same.
In healthcare, what is not provided can be as important as what is. For example, a patient with knee pain is told, “You can either have surgery or live with the pain.” Most people choose between the two. But other options – like physical therapy or less invasive treatments—may be available. If they are not mentioned, patients often do not think to ask.
“Many patients are told they need a knee replacement,” Pietropaoli said. “If they hesitate, the alternative is living with pain. In fact, there are often more options — but if they’re not offered, patients don’t know to look for them.”
Why can patients say yes to doctors?
Medical decisions are not made in a neutral context. Patients often suffer from worryingand working with unfamiliar information. Physicians have expertise, control the conversation, and represent institutional authority.
This creates a power gradient—a power imbalance that makes it harder to question or reverse. Recent research suggests that this pattern is still going strong. Studies shows that while most patients want to be informed and involved, many still prefer sharing decision making or a more physician-led approach that only a small minority decide to adopt entirely on their own.
It shows how saying “yes” in healthcare is often less about consensus and more about context. stresstrust, uncertainty and power dynamics shape the way decisions are made in real time.
Anchoring and momentum in medical decisions
When the doctor prescribes, it is difficult to hear anything other than this first option, how everything feels. Anchoring relationship meaning that the first thing that is said becomes the starting point and everything after that is compared to it. Changing the status quo relies on it – once a plan is set, it’s often easier to stick to it than to stop and revise.
Together, these biases create momentum. What starts out as “here’s an option” can quickly feel like “here’s an option”. As Pietropaoli noted, “Once a treatment plan is on the table, it quietly narrows the rest of the conversation.” This can make it more difficult for patients to speak up, ask questions, or consider other options before making a decision.
What patients can do
Even small shifts can improve decision making. Here are some simple steps that can help:
- Ask about alternatives: If only one or two options are offered, there may be more. It’s okay to ask, “What else can we do?” or “Are there other approaches?” This can open up more options that you may not have been told about.
- Pause before you finish: You don’t always have to make decisions in the moment. Taking a short break can help you think more clearly and reduce stress.
- Separate diagnosis from treatment: Understanding what is happening is not the same as choosing what to do next. Take the time to make sure both are clear. This will help you quickly move from information to action.
- Payment attention uncomfortably: If something doesn’t sit right or feels rushed, it’s a signal to slow down and ask more questions – don’t ignore it.
- Search cooperation: Good care should feel like a conversation. The goal is not just to get a plan, but to create one. This will help ensure that decisions reflect both your medical experience and your values.
The bottom line
Medical decisions are not based on evidence alone. How the options are designed, who is speaking, the timing and human psychology all affect what happens in the room – often without anyone noticing.
This does not mean that patients are passive or that doctors are doing something wrong. It simply reflects how decisions work under pressure. There is no better care than just “following directions”. It comes from slowing down, offering real choices and making sure patients understand and make decisions that affect their lives.
© 2026 Ryan C. Warner, Ph.D.
