7 General discussion and summary 159 An excellent leader in dancing leads while following. The leader will set in a movement, ‘read’ the steps of the follower and adjust the movement accordingly. This can be seen as the exchange of information in the care decision conversation. The physicians shares knowledge on treatments and outcomes, the patient shares knowledge on goals and values, the physician adjusts the information to the patient. During the conversation, you constantly have to stay connected to the other one, find out where they stand, whether they come along. Whether you stick with the basic steps, or continue with more advanced dance moves (which treatments you discuss, but also whether you stay in the information provision and exchange phase or whether a decision can or should be made). Without practice, you cannot learn to dance properly, and you need to dance to practice it. You can look in a book to study the dancing steps (gain knowledge on treatments and outcomes, read about communication skills), you can watch other people dance (watch how a role model, colleague, supervisor, etc. conducts a care decision conversation), but eventually you really have to start dancing and practice to become better at it, preferably with a teacher that can provide you with personal feedback (you have to start talking about it, and receive feedback on your conversations to become better at it). Finally, if you never dance it can feel ‘awkward’ to start dancing (use of hesitations, repairs, accounts), but when you do it more often you will probably feel more comfortable. Because the physician is the professional in this setting, the responsibility for the conduct of the conversation (learning how to dance) lies most with the physician. It might seem that’s it, all necessities for two partners to perform a perfect ballroom dance. But we are not there yet, there are some surroundings that are necessary as well. It is pretty hard to dance without music (awareness; if you hear music you know you can dance; you have to be aware of the topic of care decisions in order to start a conversation about it) and if there is a dance floor this invites you to dance more. The ‘dance floor’ in care decision conversations are all practical necessities: time, physical space (e.g. in an admitted patient a private family room instead of a room with four other patients), a supporting system/ electronic health record, etc. Finally, when you see other people dancing, this stimulates others to start dancing as well. Lead by example.
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