Sir, a 70-year-old gentleman was referred by his dentist for an opinion on a grossly decayed unrestorable, albeit symptomless, lower left wisdom tooth (38). I discussed with the patient the options open to him: either surgical removal of the tooth before any symptoms occurred or leaving it until symptoms occurred and then removing it.

I advised the former and invited the gentleman to choose. He calmly took a coin out of his pocket. 'Tails, I leave it; heads, I have the tooth out,' said he. Lo and behold it was tails! I said to myself this is shared decision-making and autonomy at work – the kind I have not come across in my 32+ years of clinical practice. By the way I did not check the coin for possible bias!

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