'Patient choice' concept in AF ESC Guidelines: is the clinician giving up?

The new AF ESC focused update has very recently introduced the 'patient choice' concept. 1 What it means is that the choice between different therapeutic strategies may be directly made by the patient himself and therefore seems not necessarily related to a specific physician's advice. In our mind, this point could deeply modify current physician role. New therapies related to technical procedures such as ablations or device implanta-tions have given progressively more space to the creation of cardiological sub-specialists such as 'ablators', 'implanters', 'PCIologues', etc. Those professional figures became very smart in performing their own job but did lose the grip on the other cardiological fields. As a direct consequence the indications of a specific therapy may be exaggerated, thus limiting the patients' rights to be cured at best. For example, the cardiac surgeon may bring a patient to a precocious valvular repair intervention , consulting eventually only the echo-cardiographist. In a similar manner, the electrophysiologist may directly treat atrial fibrillation patients that ask for ablation and the haemodynamist may perform PCI even in asymptomatic patients with non-significant coronary stenosis who are seeking to reach the perfect coronary width. The role of the clinician, who knows the patients' characteristics and has a 3608 knowledge of pathologies, guidelines and therapeutic implications, is thus progressively disappearing. He is actually taking care of the patients but hardly interferes with the technical indications to therapy nowadays. He is busier and busier in management activities and drowned by bureaucracy, with a progressive loss of knowledge, experience, and clinical feeling that should be the basis and constitute the deepest sense of the medical profession. Who can advice the patient to his best if not the one who knows his path-ologies, his history, and all the clinical aspects of the body and mind of that specific individual? The 'medical technician', who could also retain some possible conflicts of interest? What does 'patient choice' mean then? Could the patient be informed by other sources such as blogs, social networks, good friends, and next-door guys? Moreover, since we are speaking of European guidelines , are all European countries able to absorb that 'choice' in the same way? Will different cultural levels and health systems organizations translate this new concept in the same way with a proper patient decision making? We are deeply worried that 'patient choice' would mean to pass from an era when the patient was fully clinically …