Clinicians' descriptions of how they involve patients in the decision-making process illustrate the challenges of implementing the principles of patient-centered care. These descriptions included the negotiation between patients' and clinicians' values and goals, which were characterized as sometimes being in conflict. Implicit in the decision-making process for some clinicians was the belief that any amount of risk reduction for a given disease-specific outcome, such as myocardial infarction, warranted intervention. However, some studies have demonstrated that, when presented with numerical data regarding risk reduction, many patients would be willing to take medication only if the amount of risk reduction exceeded the actual benefit provided by commonly prescribed therapies.18,19 Moreover, other clinicians noted that the reduction in risk for a disease-specific outcome might not be what was most important to the patient, an observation supported by studies indicating that the adverse effects of medications may be as, if not more, important to patients than their primary effects.20,21 Disagreement between patients or caregivers and clinicians regarding the goals for an individual patient's care has also been demonstrated quantitatively.22,23 Although the authors of these studies suggest that these findings indicate a lack of clinicians' awareness of the patient's priorities, the clinicians in the present study presented a more complex picture. They cited concern about patients' and families' inaccurate understanding of harms and benefits, and they described performing testing to help patients understand their risk.