How should clinicians respond to a patient requesting a service with an 'I' statement?

• A. Always proceed with the test regardless of patient values.
• B. Dismiss the patient's request.
• C. Engage in shared decision-making, discuss uncertainties, and tailor to the patient's risk profile.
• D. Explain there is no evidence and refuse.

Answer: (C)

The main idea here is handling patient requests by practicing shared decision-making that blends the best available evidence with the patient’s own values and risk factors. When a patient asks for a specific service, the clinician should invite the patient to share why they want the test, clearly lay out what the test can and cannot do, and discuss potential benefits and harms in understandable terms. It’s important to acknowledge any uncertainties in the evidence and then tailor the discussion to the patient’s individual risk profile—age, medical history, family history, and personal preferences—so the final plan reflects both what the evidence shows and what matters most to the patient.

This approach is preferable because it respects patient autonomy while ensuring decisions are informed and appropriate to the patient’s risk level. It helps prevent overuse or underuse and supports better alignment between care and the patient’s values. In contrast, automatically proceeding, dismissing the request, or refusing solely due to a lack of evidence ignores the patient’s perspective or oversimplifies the decision, missing opportunities to engage in a thoughtful, personalized discussion.