69 I Physicians say that… Time and place: Setting ● care decisions are not discussed regularly at the outpatient clinic ● their main experience with care decisions is at the emergency department or during an intensive care internship ● the best time and place for care decision conversations is debatable (they had different opinions) ● the outpatient clinic is the best place for care decision conversations when relevant (more on relevance in Intermezzo 2) ● the general practitioner is responsible for care decision conversations since (s)he knows the patient best (mentioned by a few) Time and place: Time ● lack of time is the biggest barrier to care decision conservations ■ “because it is a difficult subject, you can only bring it up if you can take the time for it” ● they experience lack of control and the required time is unpredictable ■ “because you have no idea how the patient will respond” ● they misuse time as an easy excuse as well ■ “because it is a difficult topic, so we rather talk about lab results and avoid conversations about care decision” Hooks (accounts) ● it is difficult to bring up the topic of care decisions if there is no “direct cause” ● they search for a “hook” to initiate the conversation ● they feel the need to justify the introduction of the topic of care decisions Physician-patient relationship ● the established physician-patient relationship at the outpatient clinic enables care decision conversations, although not every physician had long-term physician-patient relationships ● they sometimes feared to negatively impact the relationship through care decision conversations, when the patient became overwhelmed or anxious ● care decision conversations positively impact the physician-patient relationship due to more profound conversations and free expression of emotions
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