The principles of SDM are well documented and the common elements have been summarized. The earliest mention was in 1982, but the idea draws on and deepens the principles of patient centered care. Others provided more detail and this led to a greater focus on the skills required. Yet, despite attention to principles and competences, there remains a lack of clear guidance about how to accomplish SDM in routine practice. Our aim is to translate conceptual descriptions into a three-step model that is practical for clinicians. The purpose of this article is to advance a novel, yet pragmatic, proposal about how to do SDM in routine settings, in short to integrate good communication skills with the use of patient decision support tools.