“Buy on apples, sell on cheese” is an old proverb among wine merchants. Taking a bite of an apple before tasting wine makes it easier to detect flaws in the wine, and the buyer who does so will not as easily make the mistake of paying more than the wine is worth. Cheese, on the other hand, pairs well with wine and enhances its flavor, so a seller who offers cheese may command a higher price for the wine (and may even deserve it, if the wine is intended to be drunk with cheese).

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Every guide to decision making emphasizes the importance of goals. Decision makers must clarify their goals when making a decision, lest they make choices that will not serve their ends. To consider alternatives without knowing one’s goals is to let the tail wag the dog.

Practically speaking, most medical decision models don’t (and perhaps can’t) consider patient goals directly. Good clinicians, however, must (and do).

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