Chapter 3 56 Example 2. Topic of care decisions introduced in the data gathering phase patientrelated accountability). This is a consultation between an 81-year-old male patient (P) with chronic kidney damage and his experienced female nephrologist (D). The patient’s partner (F) also takes part in the conversation. 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 D: D: P: D: P: D: P: D: P: D: P: D: P: D: P: D: D: D: P: D: F: D: F: D: P: D: P: ((uses blood pressure meter on patient)) here it comes, yes. I am ac↑tua↓lly very happy with these results↑ it looks proper, uhm (.) it is also (.) so hi, -or so good, actually, yes? that I am no:t (.) going to give you the information about what if the kidneys stop working, ((nods yes)) that chance will <in the end> come up at some point, yes, uh(.) and then you would have to go on <dialysis>, I don’t know if you know what that is? no, ((8 lines omitted)) and u:hm (.) with these values it is definitely not relevant, no. but if it comes- becomes worse, and often is that number; right, that 27 is going towards the: [yes? [let’s <goes towards> say 15, then- ->°I am going to do it gain okay°< ((turns on blood pressure meter again)) then it can be. that the dialysis, right, comes in sight. and then of course you should have in ample time, you should get some information about that, what is it exactly, and what does that mean:? [and-uh [yes I have seen that before you see. well I think that that information (start) is really not relevant yet, uhm but it is [already a good, [-i was already afraid of that earlier before we came h[ere [yes. (than I thought like) well↑ (.) hey↑ yes. and if we then eh: right, if that <will co:me> in sight, then we should also elaborately discuss, at your age (0.3) if you would want that. (0.3) right, because you can also say with that bad kidney functioning, then I will actually try with >pills< (0.5) to keep it functioning as long as pos[sible. [yes. and that you then say that the dialysis that you say of that- that it might be a a bridge too far:, and that–that-there is something to say [for that [yes::, that is not pleasant of course. After line 145 the patient and physician continue to talk about various options and their consequences considering the patient’s age (>80) and clinical condition (good). The actual decision on whether or not to opt for dialysis is deliberately postponed and they continue the consultation with evaluation of the blood pressure, fluid status, and increasing the diuretics, etcetera.
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