This chapter reflects on arguments supporting achievement of shared decision making (SDM). Policy support for SDM has been evident in many countries and research by many groups has investigated the impact of information-rich patient-facing tools. We observe, however, that many chapters in this book deal with the challenges of implementation, recognizing that when empirical data about daily practice are examined, there is evidence that typical practice is far from the ideal described in SDM models. We outline the topics covered in the book and consider the next steps needed before change will occur. Given the powerful business forces that have shaped the delivery of medicine to become commodified, we examine what steps might be needed to re-orientate this system to focus more on customized value to individuals, to move away from an emphasis on volume to a system that uses the well-informed desires of individuals as its measure of value.