Chapter 7 162 on the potential for opting out of diagnostic or treatment interventions). And from care decisions to advance care planning (with further emphasis on aspects as how one sees the end of life, and how and where to spend the last stages of life). If you approach the topic like that, sensible care decision conversations should be a normal, regular, recurring part of the medical consultation. Care decision conversations are a continuous, dynamic process, relevant at any given time and under any kind of circumstance. Framing it as a ‘current plan’ could possibly be helpful in seeing it as currently relevant and flexible, rather than fixed. This ‘new’ narrative – care decision conversations as normal, regular, recurring part of the consultation to align treatment with patients goals and values – also removes the problem of choosing the best setting: it should not be either the outpatient clinic or the emergency department. Either the emergency department or during admission. Either the general practitioner or the hospital physician. It should be and - and - and. Patients assign physicians a key role in the care decision process, so we should all pick up this gauntlet. To accomplish the embracement and wide dissemination of this new narrative, patients, physicians and the community at large should be educated. We need to engage the physician and the patient, play some music and make sure there is a dancing floor! Physician training – learn how to start dancing, dance, and lead First of all, training in care decision conversations should be introduced into the medical curriculum. Currently this is lacking, both in the basic medical training to become a physician, and in further specialization. Besides, observing others or being observed and receive specific feedback is often lacking as well. We recommend to introduce training either at the end of the basic medical curriculum or at the beginning of specialization or clinical work We recommend incorporation of a number of important components in physicians’ training. Physicians should be educated in the role patients assign them: the expectation of patients that the physician initiates this conversation, informs them, and does so with sensitive communication skills. The training should provide the physician with background medical knowledge on certain treatments, its outcomes, and (patient)factors that influence these outcomes. Besides, the vision of care decisions as a continues process to align treatment
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