According to researchers drawing on the ideas of Jürgen Habermas, Canadian patients and Danish General Practitioners are both experiencing the ‘colonisation’ of their ‘lifeworlds’, though in different ways. Their suggested remedy is to ensure that the clinical encounter, freed of strategic rationality, prioritises Habermasian ‘communicative action’ aimed at mutual understanding. However, Blau argues that such communicative action can, and should be, inextricably interwoven with means-end rationality, rejecting Habermas’ caricature of the latter. In agreement, but taking an operational perspective, we argue that decision support based on Multi-Criteria Decision Analysis can help produce the ‘communicative means-end rationality’ essential in a public health service based on role-respecting sincerity and autonomy.