A frail 83-year-old lady, living with her husband in a village, had fallen and fractured her right hip. The optimal treatment was surgery to replace the broken hip, but both she and her husband refused the surgery out of fear and their cultural beliefs. After a lot of counselling and convincing, she underwent the surgery, but died of surgical complications a week later. I played the role of her primary care physician, in organising her surgery, counselling the family, and then providing comfort care at the end of her life. During this entire process, there were several instances when the line between my decisions about “what is best for her” and a decision based on the family’s values and preferences was blurred. Such stories — where shared decision making between the patient and the physicians remains illusory — abound in medical practice. The idea of operationalising shared decision making in typical low- and middle-income settings like India, with poor health literacy even among the educated, a weak public health system, and over-crowded health facilities, with very little time available for physician-patient interaction, leaves much to be desired.