I recently had a complaint where I’ve tried to employ shared decision making, and they felt that I was trying to manipulate and confuse them. That’s a punch in the gut. Personally, nothing cuts deeper than a patient thinking I was uncaring. And unfortunately, doing “everything” often makes it seem like we care more. Our non ER colleagues think this way too, given the number of antibiotics I’ve seen being called in for patients without any sort of personal interaction. (I didn’t know you could diagnosis pneumonia via voice mail!). At the end of the day, so long as you can justify what you did in your chart and to the person staring back in the mirror, you’re probably doing the right thing. What’s tricky about it all, is that doing the right thing, is not always the right thing, and the right thing depends on who you’re asking what the right thing is.