Day 2 Reflections

Shared Decision Making – perhaps better known as Informed Decision Making
— It would be interesting to have stock videos to educate patients about procedures, but this has to be used in conjunction with explained. (apparently this occurs with a single company out there)
— It would be cool to have specific consent forms for specific conditions that look like this (see attached pic):
— We have to be careful with numbers (risk) and make sure it’s meaningful and the data is being applied correctly and that the numbers cited are actually applicable to the case at hand.
— We can’t rely overly on numbers as there are certain things we can’t really quantify: for example, I can tell you that the rate of infection for LP is 5%, but I can’t quantify the risk of not doing the procedure – it’s hard for me to say you have a x% chance of having meningitis. The reason I am advising the procedure is because I think there is a reasonably good chance that you have meningitis and that’s why I’m recommending the LP.
— However, having more data on risks/adverse outcomes compared to what we have now would be very useful.
— If we engage in Shared Decision Making, we have to respect patient’s decisions even if we don’t agree with them (not wanting life-saving surgery because one does not want tubes/plastic coming out of one’s body even if this alternative is only temporary). We can’t just chalk the request up to a poor state of mind / lack of competence.
— It is true that in stressful situations / situations where bad news is broken or under a dangerous situation, patients may have a harder time processing information, understanding what the physician tells them, and making decisions.
— Despite not focusing on human error and the fact that we should be focusing on system error to prevent future errors, bad actors should still be punished.

— In unrelated news, we’ve had on average, one school shooting ever 8 days since Sandy Hook? How is this acceptable? We as physicians need to step up and save some lives by coming up with something sane when it comes to gun control. Arming teachers is not the answer – I don’t want to live in a police state or where everyone has guns and tries to take the law into their own hands. Physicians need to take a stand!

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