SHOULD
I've FOCUSed and REFOCUSed my mission to Provide the most useful support for healthcare decision-making.
Sometimes that means helping a clinician answer the question "What SHOULD we do?" and that means providing the most USEFUL current and accurate summary of evidence and guidance. Sometimes that means providing SUPPORT to the guideline developers so those providing the guidance can provide the most USEFUL SUPPORT for healthcare decision-making. In this context SHOULD can mean a degree of obligation -- if this is strong enough it may even become a quality measure and key driver for healthcare decisions informing "What SHOULD we do?" and reducing unwanted variability in healthcare.
Sometimes however this means helping a patient answer the question "What SHOULD I do?" and that means providing the most USEFUL current and accurate summary of evidence and guidance. But in this context the SHOULD is often specifying the course of action that best fits the patient's goals. And this could be appropriately increasing variability in healthcare as patients have different goals. Each patient values the "benefits" and "harms" differently when considering the trade-offs among options. Providing the most USEFUL SUPPORT can be providing patient decision aids so they can see the trade-offs for themselves. Or it can be providing SHARED DECISION MAKING (SDM) tools to facilitate the patient and clinician discussing together "What SHOULD I do?" for the patient. Sometimes it can mean providing SUPPORT to the SDM tool developers so those providing the SDM tools can provide the most USEFUL SUPPORT for healthcare decision-making.
This MISSION (Provide the most useful support for healthcare decision-making) is something that will take many people working together (NETWORKING for the NET WORK, and MAXIMAL COLLABORATION) with MULTIDIMENSIONAL considerations and MULTIFACETED perspectives.
If you are one of the many people I am fortunate to be collaborating with to make this happen, you are BUSY helping people figure out what they SHOULD do. I guess that makes you a SHOULDer. And you do it because of some sense that you SHOULD. And you want to SUPPORT (or SHOULDER) the efforts of others. But if you are a SHOULDer you SHOULD consider how much influence you ultimately have and thus SHOULD be careful in how you do what you do. You SHOULD not take on such efforts unless you are ready to SHOULDER the responsibility for it. So, SHOULD you be a SHOULDer to SHOULDER what you SHOULD?