From Power Imbalance to Partnership — Dartmouth's Dr. Glyn Elwyn: Meaning & Purpose in the Exam Room

World leader in shared decision-making Dr. Glyn Elwyn (Dartmouth) joins Judson to unpack co-production in healthcare: what it looks like in real visits, why simple tools like Option Grid change choices, and how SDM can protect clinicians from burnout and moral injury while improving outcomes and patient trust. Glyn traces his path from rural Wales—through a lab explosion, an arts degree, and a "back-door" into medicine—to building the field's most used measures (Observer OPTION-5, CollaboRATE) and pushing health systems to become true learning health systems. We also explore ambient listening, elective surgery utilization, primary-care access, and what leaders (and payers) can do tomorrow. What we cover • Power asymmetry in the exam room & how to level it • Option Grid, Observer OPTION-5, CollaboRATE / Integrate / Considerate — what they measure and why they matter • Why informed patients often choose more conservative options • Evidence Glyn cites on reduced elective surgeries with decision aids • SDM's upside for clinicians: relationship depth, reputation, resilience, and reduced burnout • Learning health systems that actually learn (CF, pediatric IBD) • Ambient listening → feedback loops that coach better decisions • Leadership moves for executives, payers, and policymakers About our guest Glyn Elwyn, MD, PhD — Professor at Dartmouth; pioneer of shared decision-making and patient decision aids. Chapters 00:00 — Intro 01:18 — Introducing Dr. Glyn Elwyn and co-production in healthcare 03:00 — Dr. Glyn Elwyn's personal background and early education 10:06 — Impact of arts education on medical practice 12:01 — Entering medical school and early medical career 16:07 — Development of shared decision-making measurement tools 19:39 — Challenges and early reception of shared decision making 22:27 — Philosophy and practicalities of shared decision making 26:41 — Benefits of SDM on outcomes and utilization 28:47 — Career progression and expansion of SDM research 30:13 — Creation and impact of the Option Grid tool 31:51 — Importance of measurement tools: CollaboRATE, Integrate, Considerate 35:36 — Frustrations with adoption of SDM measures 37:18 — Benefits of SDM for clinicians and patients 42:15 — Role of insurers and leadership in implementing SDM 44:29 — Impact of decision aids on costs and utilization 45:10 — Learning health systems: examples and challenges 50:01 — Comparing Welsh and American healthcare perspectives 51:48 — Applying SDM in a multicultural practice 55:17 — Limits of SDM in complex addiction cases 56:13 — Scaling SDM to community and cultural challenges 58:50 — SDM and physician burnout 1:03:46 — Balancing Physician Productivity and Quality Care 1:05:10 — Addressing Demand and Access Issues in Primary Care 1:06:58 — Future Directions and Implementation Challenges 1:08:48 — Policy and System-Level Perspectives on Shared Decision Making 1:10:22 — Reflections on Healthcare Spending and Systemic Issues 1:12:29 — Call for Leadership and Vision in Healthcare Reform 1:14:13 — Closing Thoughts and Legacy of Shared Decision Making Advocacy Support the show If this helped, please like, subscribe, and share with a colleague who cares about better decisions and a sustainable workforce.