Today’s discussions revolved around the importance of involving patients and families in care planning. We touched on a number of important topics within this theme — informed consent, outpatient medication choices, code status/goals of care, and much more. I appreciated that today’s SDM discussion was paired with a fantastic workshop on negotiation led by Paul Levy, which broadened the concept of negotiation for me. Some of the stories regarding SDM were striking. Parents having procedures performed on their children without their knowledge or consent. Patients consenting while heavily sedated. Many terrifying stories today. I think the toughest barriers to involving patients and families in care planning are the incredible asymmetry of knowledge and the difference in perception of severity between provider and patient. What I consider a routine procedure or a common medication may be the biggest risk/benefit decision the patient has ever had to make. We need educational systems to emphasize and formalize our approach to these questions so that at the very least we are clearly aware of when our decision making is clearly NOT shared and deserves to be. As Don Berwick shares, “nothing about me without me.”
