As we were going through the video and watching as the neurosurgeon explained the situation and presented the option of surgery as the only lifesaving option, it seemed to me that he had some sort of professional bias to preform that procedure. Even as the PCP tried to weigh in and tell the family it was benign and the would need to follow up with repeat MRI in a few months, the surgeon wrote that second opinion off. As a primary care resident, I take care of my own patients in the hospital, many of whom I have had the opportunity to get to know very well and understand how they think and what is important to them. If we consider informed consent more of a process or a dialogue, it seems that the patients PCP would be an important contributor, almost an advocate for the patient who can act as an unbiased medical mind to aid in the patient’s decision making process. I think that we are included in these decisions to a certain extend, the patient may have the opportunity to think the decision through and ask our opinion, but this is not a requirement for informed consent. I also understand that PCP involvement in hospital care is much different throughout the many healthcare systems, but it is something to think about and there may be other options or ways to get primary care docs involved in this decision making process.