Introduction
I've noticed something odd over my years in medicine. Sometimes we use terms that sound like they mean one thing, but they actually mean something entirely different.
It's not always intentional. But it creates confusion.
Here's a recent example. You may have heard that RFK Jr. made changes to childhood immunization recommendations. The language used in those changes reveals how confusing medical terminology can be.
Let me walk you through a few terms that don't add clarity to what they're intended to do.
"Shared clinical decision-making"
This one sounds empowering. It sounds like the patient or parent is being invited into the decision-making process.
But here's what the term actually means in medical practice.
Shared clinical decision-making (SCDM) refers to situations where the evidence doesn't point to one clear default for everyone. There are multiple treatment options to consider. The term indicates that the healthcare provider should walk parents through the different options to help them make a decision.
It's a description of the educational process expected of the provider.
It isn't intended to imply involvement in decisions in general. Parents have always been the ones who give consent for their children's healthcare, including immunizations.
Many vaccines on the childhood immunization schedule were recently changed from "recommended" to "shared clinical decision-making." The term sounds empowering. But it's mainly a change in how the recommendation is categorized, not a claim that the vaccine stopped working.
Changing the label from "recommended" to "shared clinical decision-making" doesn't change parental consent. That existed before the title changed. But because the label is vague to most people, it can still be confusing which vaccines are broadly beneficial and which are situation-dependent.
"Informed consent"
This is another term that sounds straightforward but gets complicated in practice.
Informed consent is the process by which patients (or parents) are informed about the risks, benefits, and alternatives of a recommended treatment or procedure. The clinician explains why the treatment is recommended, discusses the risks and benefits, and answers questions.
The point of informed consent is to ensure the patient understands the procedure or treatment so they can make an informed decision. It isn't just about offering information to the patient.
The goal is to help patients have an accurate and balanced view of the risks and benefits of immunizations.
When this term gets misused, it can sound like doctors are trying to withhold information or limit choice. That's not what it means.
Immunization "requirements"
There is no universally required vaccine in the U.S. There are areas where specific age-appropriate childhood immunizations are required for school attendance or certain activities.
Because many school immunization requirements use the CDC childhood vaccine schedule as guidance, the childhood vaccine schedule has been inaccurately framed as a vaccine mandate in itself.
This misrepresents the purpose of the childhood vaccine schedule. The schedule is meant to provide evidence-based recommendations about which vaccines are beneficial for children and when is the best time to get them based on children's development and risk of exposure.
Patient autonomy
Here's a quote from a court case more than 100 years ago: "Every human being of adult years and sound mind has a right to determine what shall be done with his own body."
That's a central principle of medical ethics.
The goal of patient autonomy is to protect patients' right to make decisions. It's not suggesting patients should make health decisions without external help.
Recommendations and input from clinicians aren't there to limit choice. They're meant to help patients make their own decisions by empowering them with health information and synthesizing complex evidence.
What does this all mean?
I believe patient autonomy, shared decision-making, and informed consent are foundational to medical care in the U.S.
But I've watched these concepts get twisted into rhetoric that claims to empower patients while creating confusion and driving a wedge of distrust between patients and the physicians who want to help them.
Medical terminology can be confusing enough without the added layer of political framing.
When you hear these terms, ask questions. What does this actually mean in practice? What's being recommended and why? What are the alternatives?
The language we use in medicine should clarify, not confuse. When it does the opposite, it's worth slowing down and asking for a clearer explanation.