The Art of Clinical Negotiation.

The art of clinical negotiation is an important, yet underappreciated aspect of medicine. Key components of negotiation include the need to consider principles over personalities, to explore all options before deciding on the best course, to realize if consensus cannot be achieved then compromise may still be possible, to work from evidence to incorporate contextual factors, and to stay evidence based. These principles can be helpful in many settings, including contract negotiation, drug pricing, and research. Negotiating the balance between patient safety and efficient research methodology is central to discussions with institutional review boards and public and private researchers. When guidelines are developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, shared decision-making and negotiation of treatment plans can be seamlessly incorporated into patient conversations for conditional recommendations, and negotiation skills may facilitate clinical adoption of strong recommendation as well.