Questions to ask before deciding

Questions asked before a decision can be used to make visible what is wanted, how the options are to be understood, and which points have not yet been explained. This article runs from the questions a person can put to themselves to those they can put in the consultation. The list here is not a score or a suitability test. The aim is not to bring about a decision on a particular procedure but to keep clear what information and personal priorities the decision rests on; the AHRQ's shared decision making model likewise takes a person's values and preferences together with the options.¹

Why do I want this, and for whom?

The NHS's self-assessment questions before a decision cover what a person wants to change and whether they want it for themselves or to please someone else.² Answer these headings in your own words; rather than settling for the name of the procedure, describe the thing you want to change.²

• What do I want to change about my appearance, and why?²
• Is this wish my own, or am I trying to meet someone else's expectation?²
• Beyond my appearance, am I also expecting something in my life to change?²

The answers to these questions are not scored right or wrong here. You might, for example, keep the note describing the feature you want to change separate from the note describing why that change matters to you. Put your goal about appearance in the first and the meaning you attach to that goal in the second. This is not offered as a way of reaching a diagnosis; it is how this article organises the questions.

The detailed explanation of a goal and the meaning attached to it is in What is a realistic expectation?. Rather than redefining that concept here, the aim is to turn the change you want to describe into questions.

The NHS advises that, before a procedure, a person discuss with the practitioner why they want it and what they expect.³ In setting out your own note in the consultation, you can state first the thing you want to change and then why it matters.³ Keeping the question from resting at "which procedure" is what that advice amounts to here.

Why now, and what would waiting change?

The NHS advises considering how long the wish has been present, the current life situation, and why the procedure is being thought about now.² Timing in this section is not treated as a recovery schedule. The questions are directed at understanding why the decision has come to matter today.

• How long have I been thinking about this change?²
• Is there a particular event or situation that has prompted me to think about it now?²
• What connection am I drawing between my current life situation and the change I expect from the procedure?²

You can organise your answers as a timeline. Note separately when the wish first arose, what part of it is unchanged today, and the reasons added later. The suggestion here is about organising your own account; no suitability decision is made on the basis of how old the wish is.

The institution's questions are directed at a person thinking about their current life context; they do not define a waiting period applicable to everyone after a particular life event.² There is therefore no decision threshold in days or months in this section.

Which questions can I prepare for the consultation?

The NHS advises writing down important questions in advance, taking notes during the consultation, and checking whether the items on the list have been covered.⁴ Rather than trying to ask about every detail at once, work out first which points you want answers to.⁴

Question note: On a short page, you can keep the goal you want to describe separate from the points not yet clarified. Leave separate room for the question you prepared, the answer given, and the point you still do not understand. This arrangement is a practical suggestion of this article; it is not an official form to be completed.

Try to make your questions more specific than general headings. Instead of writing only "options", for example, state which options you want to compare; instead of writing only "outcome", state which outcome you want explained. The aim here is not to appear to have learnt the technical terms but to keep your own question from getting lost. Your notes do not have to be long or written in medical language.

Questions about certificates and authority are dealt with separately in How do you verify a specialist?. Rather than setting out that group of questions again here, keep the questions about your decision and that information as distinct subjects.

The NHS page on choosing a practitioner also advises asking for information you can take away and read after the consultation.⁵ You can ask for the written counterpart of an explanation and read it again alongside your own note.⁵ Add the question about written information next to the point you want clarified in the consultation. Marking which of your questions a document answers is part of the note arrangement suggested in this article; do not treat the list of questions as complete merely because you have obtained a document.

What should I clarify when comparing the options?

The Agency for Healthcare Research and Quality (AHRQ) of the United States describes shared decision making as weighing the benefits, harms and risks of the options together with what matters to the person.¹ Within that frame, the question is not only which options exist but how an option relates to the person's goal.¹

• Which options exist in respect of the change being sought?⁶
• How do the possible benefits and risks of those options differ?⁶
• What possible benefits and risks arise if no procedure is performed?⁶

Article 15(c) and Article 15(d) of the Patient Rights Regulation govern the giving of information about other options and their possible effects, and about the benefits and risks that may arise on refusal.⁶ These questions should be used not as an instruction to choose a method but as the frame of the comparison that needs to be explained.

There is also a researched counterpart to decision support. A Cochrane review examined 71 different decisions across 209 studies and 107,698 participants; 9 studies concerned joint replacement, and aesthetic procedures were not examined.⁷ Structured decision aids were reported to produce positive results for knowledge, understanding of risks and participation in the decision.⁷ For the separate outcome of decision regret, in the results of the 22 studies and 3,707 participants assessing it, no difference was found against usual care, on high-certainty evidence.⁷ Knowledge and participation in the decision, and regret measured after the decision, were assessed as separate outcomes in the review.⁷ The list of questions here, moreover, is not an instrument tested in that review; no claim is made that reading this article will change the outcome of an aesthetic procedure.

When comparing the answers, keep what matters to you in view as well. In the AHRQ model, a person's values and preferences stand as a separate component of the decision alongside the evidence about the options.¹ Write into your list not only the names of the options but also what you weigh in the comparison.¹

What can I do if I did not understand the answer, or it remained unclear?

You can say which point you did not understand and ask for the word used to be explained and, where needed, written down; the NHS lists these requests among its consultation advice.⁴ Checking in your own words that you have understood, after the explanation, is among the same advice.⁴

• Can this explanation be repeated in plainer words?⁴
• Can the meaning of the term used be written down and explained?⁴
• Can what has been understood be repeated back to check whether it was understood correctly?⁴

Article 18 of the Patient Rights Regulation governs the giving of information as plainly as possible and in a way the person can understand.⁶ Asking for an understandable explanation is therefore not merely a preference about communication; it sits within the regulation's frame for giving information.⁶

The point left open: State in your note which question was left unanswered. You can write separately about not knowing the meaning of a word and about not yet having received the explanation on the subject raised. Mark the word in the first case and the underlying question in the second. This distinction is not for making a new medical assessment but for showing the point you want explained again.

The regulation's provision on giving understandable information is not used here as a demand that an outcome be guaranteed.⁶ Where the answer to a question is not understood, state first which part of the explanation was incomplete; this article does not offer a checklist that passes judgement on a physician's competence or on the outcome of a procedure on the basis of an unclear answer.

Paragraph 4 of the same article provides that a patient may request a second opinion on their state of health from another physician regarding the same complaint.⁶ Only that right is noted here; how a second opinion is to be obtained, or how to choose between opinions, is not described.

Can I defer or change the decision?

The NHS also states that time to think should be given after the consultation, and that a person does not have to continue if they do not feel completely comfortable.³ That a consultation has taken place does not mean you have to decide in favour of the procedure.³ The advice about time here is not conveyed as a fixed number of days or a legal period in Türkiye.

The legal basis in Turkey has to be considered separately. Article 18 of the Patient Rights Regulation provides that, except in emergencies, information is to be given allowing the patient a reasonable period.⁶ That provision is not converted here into a particular number of days to be applied to everyone.

Article 25 governs the right to refuse, or to request the stopping of, a planned or ongoing treatment, save in cases required by law and on the basis that responsibility for any adverse consequences rests with the patient.⁶ The same paragraph also requires the consequences of the treatment not being applied to be explained and recorded in a written document.⁶

A separate paragraph of the article states that exercising this right cannot be used against the patient on their return to the health facility.⁶ This article focuses on deferring the decision before a procedure or deciding not to proceed; it does not separately describe how a request to stop ongoing treatment is handled.

Revisiting the decision: This list of questions has no answer key. Recording the answers can be kept separate from recording a decision to proceed, defer or not proceed. This is the arrangement suggested by the article; a decision to proceed is not expected.

References

1. Agency for Healthcare Research and Quality. The SHARE Approach: A Model for Shared Decision Making. AHRQ Pub. No. 14-0034-1-EF. April 2016. ahrq.gov ↩ ↩² ↩³ ↩⁴ ↩⁵

2. NHS. Is a cosmetic procedure right for me? Page last reviewed 9 May 2023. nhs.uk ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

3. NHS. Before you have a cosmetic procedure. Page last reviewed 22 May 2023. nhs.uk ↩ ↩² ↩³ ↩⁴

4. NHS. What to ask your doctor or other healthcare professional. Page last reviewed 12 January 2023. nhs.uk ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

5. NHS. Choosing who will do your cosmetic procedure. Page last reviewed 23 June 2023. nhs.uk ↩ ↩²

6. Ministry of Health. Patient Rights Regulation. Official Gazette, 1 August 1998, no. 23420. Articles 15(c), 15(d), 18 (including 18/4) and 25. saglik.gov.tr ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹²

7. Stacey D, Lewis KB, Smith M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2024;1(1):CD001431. doi:10.1002/14651858.CD001431.pub6 ↩ ↩² ↩³ ↩⁴